Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease.
Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease.
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DOI：
10.1016/j.amjmed.2021.09.016
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Orman ES
中科院分区：
文献类型：
--
作者：
Yoder L;Mladenovic A;Pike F;Vuppalanchi R;Hanson H;Corbito L;Desai AP;Chalasani N;Orman ES
肝病患者的早期再入院率很高，但目前还没有有效的、可扩展的干预措施来降低这种风险的研究。在这项研究中，我们研究了医生助理（PA）领导的出院后过渡性肝脏诊所（TLC）对再入院的影响。我们对2019年在三级护理中心住院期间由肝病专家就诊的所有成年人（不包括移植患者）进行了一项队列研究。我们比较了参加TLC的患者与未参加TLC的患者在30天内的再入院率和死亡率。使用倾向评分调整建模来控制混杂因素。在498例患者中，98例出现在TLC中。35%患有酒精性肝病，58%患有肝硬化。参加者在人口统计学、肝病特征和严重程度、合并症和出院处置方面与非参加者相似。30-TLC参与者的日累积再入院发生率为12%，而非参与者为22%（p=0.02），而30天死亡率相似（2.0% vs. 4.3%; p=0.29）。在使用倾向评分调整的模型中，TLC出勤率与再入院率降低相关（SHR 0.52; 95% CI，0.27-0.997; p=0.049）。TLC在女性中的作用大于男性（p=0.07）和无慢性肾脏疾病的患者（p=0.02），但其他亚组之间无差异。在PA主导的TLC中观察到的肝病患者可能会显著降低30天再入院率。需要随机试验来确定PA主导的出院后过渡性护理对这一人群的疗效。
Patients with liver disease have high rates of early hospital readmission, but there are no studies of effective, scalable interventions to reduce this risk. In this study, we examined the impact of a Physician Assistant (PA)-led post-discharge Transitional Liver Clinic (TLC) on hospital readmissions. We performed a cohort study of all adults seen by a hepatologist during admission to a tertiary care center in 2019 (excluding transplant patients). We compared those who attended the TLC with those who did not with respect to 30-day readmission and mortality. Propensity score-adjusted modeling was used to control for confounding. Of 498 patients, 98 were seen in the TLC. 35% had alcoholic liver disease, and 58% had cirrhosis. Attendees were similar to non-attendees with respect to demographics, liver disease characteristics and severity, comorbidities, and discharge disposition. 30-day cumulative incidence of readmissions was 12% in TLC attendees, compared to 22% in non-attendees (p=0.02), while 30-day mortality was similar (2.0% vs. 4.3%; p=0.29). In a model using propensity score adjustment, TLC attendance remained associated with reduced readmissions (SHR 0.52; 95% CI, 0.27–0.997; p=0.049). The effect of TLC was greater in women compared to men (p=0.07) and in those without chronic kidney disease (p=0.02), but there were no differences across other subgroups. Patients with liver disease seen in a PA-led TLC may have a significant reduction in the 30-day readmission rate. Randomized trials are needed to establish the efficacy of PA-led post-discharge transitional care for this population.
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DOI：
10.1016/j.cgh.2019.04.048
发表时间：
2020-02
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
通讯作者：
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影响因子：
2.9
作者：
Garg, Sushil K.;Sarvepalli, Shashank;Leise, Michael D.
通讯作者：
Leise, Michael D.
影响因子：
3.5
作者：
Mitchell SG;Schwartz RP;Alvanzo AA;Weisman MS;Kyle TL;Turrigiano EM;Gibson ML;Perez L;McClure EA;Clingerman S;Froias A;Shandera DR;Walker R;Babcock DL;Bailey GL;Miele GM;Kunkel LE;Norton M;Stitzer ML
通讯作者：
Stitzer ML
影响因子：
25.7
作者：
Morando, Filippo;Maresio, Giulio;Angeli, Paolo
通讯作者：
Angeli, Paolo
影响因子：
9.8
作者：
Volk, Michael L.;Tocco, Rachel S.;Bazick, Jessica;Rakoski, Mina O.;Lok, Anna S.
通讯作者：
Lok, Anna S.