The Cirrhosis Medical Home: A Feasibility Study

项目总结 肝硬变给个人和社会带来了沉重的负担，导致生活质量下降， 残疾、发病率和死亡率增加；医疗保健资源的成本和利用率高。这些 利用现有资源可以改善结果，但目前卫生保健的支离破碎性质 这一制度不允许进行必要的协调，以最好地照顾这一群体。向将军发表讲话 在医疗保健系统中缺乏护理协调的情况下，协作护理模式已被广泛开发 在各种临床环境中，已经成功地改善了对许多慢性病患者的护理。 印第安纳大学医学院的研究人员有20多年的开发经验， 测试和实施对痴呆症、抑郁症和其他疾病患者的协作护理。 在这些成功的基础上，调查人员定制了协作护理模式，以最好地满足 失代偿期肝硬变患者的独特需求：肝硬化医疗院(CMH)。这项建议 目的是建立一项比较CMH和常规护理的随机对照试验的可行性 适用于失代偿期肝硬变出院患者。具体目标是：(1)测试 CMH与患者常规护理比较的随机试验的筛查和登记过程 失代偿期肝硬变患者出院；(2)评估数据收集过程、结果 评估，以及CMH随机试验的可接受性；以及(3)估计CMH的效果大小 6个月后对生活质量的干预。在完成拟议的研究后，调查人员将 已经证明了在CMH的随机试验中登记和保留受试者的可行性，他们 将建立一个估计的效应大小，以确保为未来的随机试验提供足够的动力 将评估CMH的疗效。

PROJECT SUMMARY Liver cirrhosis places a significant burden on individuals and society, causing diminished quality of life, increased disability, morbidity, and mortality; and high costs and utilization of health care resources. These outcomes could be improved with existing resources, but the current fragmented nature of the health care system does not allow for the necessary coordination to best care for this population. To address the general lack of care coordination in the health care system, collaborative care models have been developed for a wide range of clinical settings, and have successfully improved care for patients with numerous chronic diseases. Researchers at the Indiana University School of Medicine have over 20 years of experience in developing, testing, and implementing collaborative care for patients with dementia, depression, and other conditions. Building on these successes, investigators have customized the collaborative care model to best meet the unique needs of patients with decompensated cirrhosis: The Cirrhosis Medical Home (CMH). This proposal aims to establish the feasibility of performing a randomized controlled trial comparing the CMH to usual care for patients discharged from the hospital with decompensated cirrhosis. The specific aims are: (1) to test the screening and enrollment processes for a randomized trial of the CMH compared to usual care for patients discharged from the hospital with decompensated cirrhosis; (2) to assess the data collection process, outcome assessment, and the acceptability of the CMH randomized trial; and (3) to estimate the effect size of the CMH intervention on quality of life after six months. Upon completion of the proposed study, the investigators will have demonstrated the feasibility of enrolling and retaining subjects in a randomized trial of the CMH, and they will have established an estimated effect size that will ensure adequate power for a future randomized trial that will evaluate the efficacy of the CMH.