Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.646
Peer-review started: January 29, 2019
First decision: March 3, 2019
Revised: June 12, 2019
Accepted: July 4, 2019
Article in press: July 5, 2019
Published online: August 27, 2019
Intervention to improve outcomes in cirrhotic patients (CP) after hospital discharge often focus on 30 d readmission rate (RR). However, recent studies suggest dissociation between RR and survival. At our center, CP are now offered outpatient telephonic transitional care (OTTC) by a care coordinator for 30 d after hospital discharge.
To determine the effect of OTTC on survival in CP.
In this cohort study from a tertiary center, CP who received OTTC formed the intervention group. They were compared with a control group discharged during the same period. Mortality and RR were compared between the groups.
After OTTC introduction, 194 CP were discharged. After applying exclusion criteria, 169 CP (51% male, mean age 58 years ± 12 years) were included. OTTC group comprised 76 patients and was compared with 93 controls. Baseline disease and index admission related characteristics were not significantly different between the groups. The intervention group showed significantly higher 6 mo survival compared to controls (84.2% vs 68.8%; P = 0.03), while RR at 1, 3, and 6 mo were comparable. On multivariable analysis, the intervention group showed lower odds for mortality compared to the controls (hazard ratio: 0.4; 95% confidence interval: 0.2-0.82; P = 0.012), while higher model for end-stage liver disease scores were associated with higher mortality (hazard ratio: 1.05; 95% confidence interval: 1.01-1.1; P = 0.024).
CP provided OTTC had higher 6 mo survival compared to controls without a difference in RR. Use of RR to gauge quality of care provided during hospitalization or subsequent transitional care programs should be revisited.
Core tip: We share results of a novel intervention that provides transitional care via telephone to cirrhotic patients after hospital discharge. Over a 6 mo follow-up, the intervention group experienced 60% lower odds for mortality compared to controls with similar readmission rates. Our manuscript not only describes an effective transitional care program to improve post-discharge outcomes in cirrhotic patients but also highlights the need to acknowledge the dissociation between readmissions and survival in this population.