Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Randomized intervention and outpatient follow-up lowers 30-d readmissions for patients with hepatic encephalopathy, decompensated cirrhosis
Antoinette Pusateri, Kevin Litzenberg, Claire Griffiths, Caitlin Hayes, Bipul Gnyawali, Michelle Manious, Sean G Kelly, Lanla F Conteh, Sajid Jalil, Haikady N Nagaraja, Khalid Mumtaz
Antoinette Pusateri, Claire Griffiths, Caitlin Hayes, Sean G Kelly, Sajid Jalil, Khalid Mumtaz, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Kevin Litzenberg, Michelle Manious, Division of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Bipul Gnyawali, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Lanla F Conteh, Division of Gastroenterology and Hepatology, The Ohio State Wexner Medical Center, Columbus, OH 43210, United States
Haikady N Nagaraja, Division of Biostatistics, The Ohio State University, Columbus, OH 43210, United States
Author contributions: Pusateri A and Mumtaz K study design, team administration, training team members for recruiting, recruiting patients for study, interpreting data, drafting manuscript; both approved the final submitted version of this manuscript; Litzenberg K, Griffiths C, Hayes C, Gnyawali B and Manious M recruiting patients for study, drafting manuscript, approved the final submitted version of manuscript; Jalil S, Kelly S and Conteh L reviewed and edited the final draft of the manuscript; Nagaraja K analyzed data, edited manuscript, and approved the final submitted version of this manuscript.
Supported by GASTR29: Prospective validation of readmission risk score and interventions to prevent readmission in patients with decompensated cirrhosis (CCTS ID#: 6018).
Institutional review board statement: This study was conducted at the Ohio State University Wexner Medical Center (OSUWMC), Columbus, Ohio from July 2019 to December 2020. Our study was approved by OSUWMC Institutional Review Board. All aspects of the studying involving human participants including informed consent for enrollment were in accordance with the ethical standards of our Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Clinical trial registration statement: Since our randomized trial was of a nursing intervention only, it was not an official randomized control clinical trial that needed registering on a national level.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Antoinette Pusateri, MD, Doctor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 2nd Floor Doan Office Tower 395 W. 12th Avenue, Columbus, OH 43210, United States. antoinette.pusateri@osumc.edu
Received: December 22, 2022
Peer-review started: December 22, 2022
First decision: February 14, 2023
Revised: March 23, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: June 27, 2023
ARTICLE HIGHLIGHTS
Research background
Decompensated cirrhosis (DC) is a leading cause of morbidity and mortality in the United States often requiring multiple hospitalizations to manage. Studies show 20%-37% of patients with DC are readmitted within 30 d of index admission, which has significant burden on patients, their families and the healthcare system.
Research motivation
We were motivated to study and reduce readmissions as we see the physical, mental and emotional toll repeated hospitalizations for DC take on our patients and their families.
Research objectives
We sought to enroll patients in a randomized trial seeing if a nurse case manager (CM) ensuring early outpatient follow up, medication compliance and outpatient paracentesis if needed reduced readmissions in patients with DC.
Research methods
We sought to enroll patients in a randomized trial seeing if a nurse CM ensuring early outpatient follow up, medication compliance and outpatient paracentesis if needed reduced readmissions in patients with DC.
Research results
While our calculated sample size was not achieved due to the coronavirus disease 2019 pandemic, we found a 33.75% 30 d readmission rate in our patients admitted with DC. There was no difference in readmission between intervention and standard of care arms. Most patients were re-admitted with hepatic encephalopathy. There was a lower 30 d readmission rate in patients with hepatic encephalopathy in the intervention arm and those who attended early outpatient follow up.
Research conclusions
Our 30 d readmission was higher than the national rate. Further efforts should explore the positive impact of a nurse CM and early outpatient follow up in reducing readmissions for patients with cirrhosis, especially with hepatic encephalopathy.
Research perspectives
Further development of strategies to predict and reduce readmissions for patients with DC should be done.
