Health IT generated PROs to Improve Outcomes in Cirrhosis

健康 IT 生成 PRO 来改善肝硬化的治疗结果

• 批准号: 10374779
• 负责人: Jasmohan S Bajaj
• 金额: $ 39.46万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-11 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10374779
• 关键词: Health; generated; PROs; Improve; Outcomes

Patients with cirrhosis are prone to clinical and psycho-social issues that manifest as patient-reported outcomes (PRO), which can independently predict hospitalization, re-hospitalizations and death. Our group has studied the impact of these PRO extensively. With the increasing spread of health-related electronic devices, the relevance of health IT in the management of chronic diseases such as cirrhosis is paramount. The team has already developed and used several health IT advances to educate patients and their caregivers in inpatient and outpatient settings. These tools include Patient Buddy to prevent avoidable readmissions and EncephalApp Stroop to detect and guide therapy for cognitive dysfunction in cirrhosis. However the evaluation of these tools in a multi-center study that adapts to the status of the patients and their caregivers is required. The central hypothesis is that cirrhotic patients randomized to health IT interventions that elicit PROs in a structured outpatient setting will have a significantly greater reduction in hospital readmissions because of improved communication with their medical teams compared to standard of care regardless of scheduled return outpatient visits. This will be tested using the following two specific aims in three centers (Virginia Commonwealth University, Richmond VA Medical Center and Mayo Clinic). Specific Aim 1: To evaluate in a multi-center, randomized trial the effectiveness of PROs elicited using PatientBuddy and EncephalApp with and without scheduled outpatients return visits on the prevention of avoidable 30 day readmissions in patients with cirrhosis and their caregivers compared to standard of care. We will include 450 total cirrhotic patients and 450 caregivers (150 patients and 150 caregivers per center), who will be followed for 30 days post-discharge. The groups will be randomized 1:1:1 into a standard of care group, a group receiving health IT interventions who will receive PatientBuddy and EncephalApp with as-needed follow-up and another group that receives the same health IT interventions along with scheduled outpatient visits and calls within 30 days of discharge. Avoidable readmissions will be adjudged using a blinded adjudication committee and the differences between the three groups will be compared. Specific aim 2: To incorporate the opinion of key stakeholders (patients, caregivers and nurse managers) towards improving the Patient Buddy App in the prevention of readmission in cirrhosis. As part of this trial, we will also elicit feedback regarding the ease, safety and personal effectiveness of these interventions as well as their personal comfort and educational value of the App with and without the scheduled outpatient follow-up, from the patients, caregivers and administering staff. This will be compared between centers and used to enhance the Patient Buddy App in collaboration with our technology partners. The updated App will then be available for future studies in larger cirrhosis populations.

肝硬化患者容易出现临床和心理社会问题，表现为患者报告的 结果（PRO），可以独立预测住院，再住院和死亡。我们集团 已经广泛研究了这些PRO的影响。随着健康相关电子产品的日益普及， 医疗信息技术在肝硬化等慢性疾病管理中的相关性至关重要。的 一个团队已经开发并使用了几项医疗IT进步来教育患者及其护理人员， 住院和门诊设置。这些工具包括患者伙伴，以防止可避免的再入院， EncephalApp Stroop用于检测和指导肝硬化认知功能障碍的治疗然而，评价 在多中心研究中，需要这些工具，以适应患者及其护理人员的状况。 中心假设是，随机分配到健康IT干预组的阿尔茨海默病患者， 结构化的门诊设置将大大减少再入院率， 与标准护理相比，由于与医疗团队的沟通得到了改善 无论是否安排门诊复诊。这将通过以下两个具体目标进行测试， 三个中心（弗吉尼亚联邦大学、里士满VA医疗中心和马约诊所）。 具体目标1：在一项多中心随机试验中评价使用 PatientBuddy和EncephalApp有和没有定期门诊患者回访预防 与标准治疗相比，肝硬化患者及其照顾者可避免的30天再入院率 护理。我们将包括450名总阿尔茨海默病患者和450名护理人员（150名患者和150名护理人员， 中心），将在出院后随访30天。各组将以1：1：1的比例随机分配至标准 护理组，接受健康IT干预的一组，他们将接受PatientBuddy和EncephalApp， 按需随访，另一组接受相同的健康IT干预，沿着 出院后30天内的门诊访视和电话。将使用设盲的 比较评审委员会和三组之间的差异。 具体目标2：纳入关键利益相关者（患者、护理人员和护士）的意见 管理人员），以改善患者好友应用程序在预防肝硬化再入院。作为 作为这项试验的一部分，我们还将征求有关这些药物的易用性、安全性和个人有效性的反馈。 干预措施，以及他们的个人舒适和教育价值的应用程序与和没有预定的 门诊随访，来自患者、护理人员和管理人员。这将被比较， 中心，并用于与我们的技术合作伙伴合作增强患者好友应用程序。的 更新后的应用程序将可用于更大肝硬化人群的未来研究。

项目成果

Minimal Hepatic Encephalopathy and Mild Cognitive Impairment Worsen Quality of Life in Elderly Patients With Cirrhosis.

• DOI: 10.1016/j.cgh.2020.03.033
• 发表时间: 2020-12
• 期刊: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
• 作者: Bajaj JS;Duarte-Rojo A;Xie JJ;Acharya C;Wade JB;Robles C;Thacker LR;Flud C;Fagan A;Garcia-Saenz-de-Sicilia M;White MB;Kelly M;Nguyen V;Gavis EA;Vargas HE
• 通讯作者: Vargas HE

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.

• DOI: 10.2196/24639
• 发表时间: 2021-04-09
• 期刊: Journal of medical Internet research
• 影响因子: 7.4
• 作者: Acharya C;Sehrawat TS;McGuire DB;Shaw J;Fagan A;McGeorge S;Olofson A;White MB;Gavis E;Kamath PS;Bergstrom L;Bajaj JS
• 通讯作者: Bajaj JS

What diet should I recommend my patient with Hepatic Encephalopathy?

• DOI: 10.1007/s11901-020-00510-4
• 发表时间: 2020-03
• 期刊: Current hepatology reports
• 作者: Shaw J;Tate V;Hanson J;Bajaj JS
• 通讯作者: Bajaj JS

Cost-effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis.

• DOI: 10.1002/ygh2.390
• 发表时间: 2020-03
• 期刊: GastroHep
• 作者: Bajaj JS;Acharya C;Sikaroodi M;Gillevet PM;Thacker LR
• 通讯作者: Thacker LR

Sex is associated with differences in gut microbial composition and function in hepatic encephalopathy.

• DOI: 10.1016/j.jhep.2020.06.046
• 发表时间: 2021-01
• 期刊: Journal of hepatology
• 影响因子: 25.7
• 作者: Saboo K;Shamsaddini A;Iyer MV;Hu C;Fagan A;Gavis EA;White MB;Fuchs M;Heuman DM;Sikaroodi M;Iyer RK;Gillevet PM;Bajaj JS
• 通讯作者: Bajaj JS