Improving cirrhosis care: The potential for telemedicine and mobile health technologies

Table 1 Interventions targeting hepatitis C treatment, cirrhosis care and readmissions, and liver transplant recipients

Study	Population	Modality	Findings
Interventions targeting hepatitis C treatment
Arora et al[40], 2011	Patients with hepatitis C in rural areas and prisons in New Mexico (n = 261), compared to in-person visits at a University clinic (n = 146)	Videoconferences at ECHO site between community physicians and specialists, compared to in person visits at a University clinic	Comparable rates of SVR were seen between ECHO model and those seen in person at the University HCV clinic (58.2% vs 57.5%, P = 0.89)
Marciano et al[14], 2017	Providers treating hepatitis C in the Patagonia Region in South America (n = 14)	Videoconferences at ECHO sites between community physicians and those at a University Hospital in Argentina	Survey data focused on skills and competence in hepatitis C before and after 6 months of participating in the project, ultimately showing significant improvement in provider confidence regarding their ability to stage fibrosis, determine appropriate candidates for treatment, and select appropriate HCV treatment
Rossaro et al[17], 2008	Patients with hepatitis C in rural California (n = 103)	Videoconference between patients and specialists	23% of patients were candidates for therapy, 15 patients were evaluated for liver transplant
Talal et al[19], 2018	Patients with hepatitis C undergoing an opioid substitution therapy program (n = 62)	Biweekly telemedicine sessions between the patient and a specialty provider during the treatment course	Of 45 treated patients, 42 (93.3%) achieved SVR
Cooper et al[18], 2017	Patients with hepatitis C in Canada receiving care from the Ottawa Hospital Viral Hepatitis Outpatient Clinic, comparing telemedicine (n = 157) and non-telemedicine (n = 1130)	Videoconference between patients and specialists	Significantly fewer telemedicine patients initiated antiviral therapy compared to non-telemedicine patients (27.4% vs 53.8%, P < 0.001). Among those treated with DAA they noted similar SVR rates (94.7% vs 94.8%, P = 0.99)
Interventions targeting cirrhosis care and readmissions
Su et al[15], 2018	Patients with liver disease in the Veterans Health Administration (VA) system receiving ECHO visits (n = 513) compared to all patients in the VHA with liver disease (n = 62237)	Virtual Consultations (through the VA SCAN-ECHO Project) compared to usual care	Propensity-adjusted mortality rates showed improved survival in the SCAN-ECHO cohort (HR of 0.54, 95%CI 0.36-0.81)
Khungar et al[24], 2017	Patients with cirrhosis received 4G tablets with wireless devices to monitor blood pressure, heart rate, weight, symptoms, and medication administration. Telehealth nurses in conjunction with primary hepatology team intervened to prevent readmissions. (n = 19 intervention, 143 control)	Remote monitoring with telehealth based early intervention	The remote monitoring/ telehealth arm had 0% of readmissions due to potentially preventable causes (fluid overload or hepatic encephalopathy) due to early outpatient interventions whereas 31% of readmissions were due to these causes in the control arm
Konjeti et al[16], 2019	Potential Liver Transplant Candidates in the VA system (n = 19091 through SCAN-ECHO and 99 seen in-person)	Virtual Consultations (through the VA SCAN-ECHO Project) compared to in-person visits	The telehealth-based triage reduced futile transplant evaluations by approximately 60%
Ganapathy et al[23], 2017	Cirrhotic patients with caregivers after hospital discharge (n = 40)	Home monitoring using an iPad with the Patient Buddy App (monitoring medication adherence, sodium intake and weights, and cognition)	17 of 40 patients were readmitted within 30 d. 8 potential readmissions related to hepatic encephalopathy were prevented via early outpatient interventions
Interventions targeting liver transplant recipients
Ertel et al[20], 2016	Post Liver Transplantation Patients (n = 20)	Telehealth home monitoring (vital sign tracking) and an educational video program	19 of the 20 patients responded to a survey, with 95% watching all videos and 100% finding them effective. 90-d readmission rate of 30% (42% lower than historical controls)
Song et al[21], 2013	Pediatric Post Liver Transplant Patients, International (n = 4)	Home monitoring and decision support using a tablet PC and a specially developed software	Four international patients/families transferred 38 records of blood tests, demonstrating that this software is technically feasible
Le et al[37], 2018	Post Liver Transplant Patients	Televisits (n = 21) versus in clinic visits (n = 21)	Similar patient satisfaction. Less commute and waiting times in the televisit group

SCAN-ECHO: Specialty Access Network-Extension for Community Healthcare Outcomes; CI: Confidence interval; HR: Hazard ratio; HCV: Hepatitis C virus; VA: Veterans Health Administration.