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©The Author(s) 2019.
World J Hepatol. Aug 27, 2019; 11(8): 646-655
Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.646
Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.646
Table 1 Comparison of baseline demographic and disease related characteristics between the groups
| Factor | Total, n = 169 | Intervention, n = 76 | Control, n = 93 | P value |
| Male | 86 (50.9) | 41 (53.9) | 45 (48.4) | 0.54 |
| Age | 58.2 ± 12.0 | 58.6 ± 11.4 | 57.9 ± 12.6 | 0.75 |
| Etiology of cirrhosis | ||||
| Alcohol | 55 (32.5) | 27 (35.5) | 28 (30.1) | |
| NAFLD | 40 (23.7) | 18 (23.7) | 22 (23.7) | |
| HCV | 27 (16.0) | 11 (14.5) | 16 (17.2) | |
| HBV | 2 (1.2) | 0 | 2 (2.2) | 0.49 |
| Combination of above | 5 (3.0) | 1 (1.3) | 4 (4.3) | |
| Others | 40 (24.9) | 19 (25.0) | 21 (22.6) | |
| MELD score during index admission | 17.7 ± 7.9 | 17.8 ± 8.6 | 17.5 ± 7.3 | 0.88 |
| Problems during initial hospitalization | ||||
| HE | 64 (37.9) | 34 (44.7) | 30 (32.3) | 0.11 |
| Infection | 51 (30.2) | 23 (30.3) | 28 (30.1) | 1 |
| AKI | 64 (37.9) | 30 (39.5) | 34 (36.6) | 0.75 |
| GIB | 57 (33.7) | 28 (36.8) | 29 (31.2) | 0.51 |
| Index admission LOS, d | 5 (3.0, 9.0) | 6 (3.0, 10.5) | 5 (4.0, 9.0) | 0.95 |
| Discharge destination | 0.43 | |||
| Home | 100 (59.2) | 41 (53.9) | 59 (63.4) | |
| Home with care | 35 (20.7) | 17 (22.4) | 18 (19.4) | |
| Skilled nursing facility | 34 (20.1) | 18 (23.7) | 16 (17.2) | |
| Follow up appointment provided prior to discharge | 138 (82.9) | 63 (82.9) | 75 (80.6) | 0.53 |
| Came for appointment | ||||
| Yes | 59 (34.9) | 27 (35.5) | 32 (34.4) | 0.98 |
| No | 63 (37.3) | 29 (38.2) | 34 (36.6) | |
| No appointment provided | 30 (17.8) | 13 (17.1) | 17 (18.3) | |
| Admitted before appointment | 16 (9.5) | 7 (9.2) | 9 (9.7) | |
| Died before appointment | 1 (0.6) | 0 | 1 (1.1) | |
| Duration between discharge and appointment | 14 (7, 28) | 14 (7, 28) | 13 (9, 23) | 0.79 |
| Readmissions within | ||||
| 1 mo | 63 (37.3) | 28 (36.8) | 35 (37.6) | 1 |
| 3 mo | 93 (55.0) | 43 (56.6) | 51 (54.8) | 0.76 |
| 6 mo | 107 (63.3) | 49 (64.5) | 58 (62.4) | 0.87 |
| Problems during initial readmission | ||||
| HE | 36 (21.3) | 21 (42.9) | 15 (26.0) | 0.11 |
| Infection | 28 (16.6) | 14 (28.6) | 14 (24.1) | 1 |
| AKI | 47 (27.8) | 22 (44.9) | 25 (43.1) | 1 |
| GIB | 17 (10.1) | 6 (12.2) | 11 (19.0) | 0.3 |
| Time between discharge and readmit, d | 24 (11, 66) | 22 (11, 59) | 23.5 (12, 57) | 0.63 |
| Readmission LOS, d | 6 (3, 10) | 5 (3, 8) | 6 (4, 12) | 0.06 |
| Alive at | ||||
| 1 mo | 156 (92.3) | 72 (94.7) | 84 (90.3) | 0.39 |
| 3 mo | 137 (81.1) | 66 (86.8) | 71 (76.3) | 0.11 |
| 6 mo | 128 (75.7) | 64 (84.2) | 64 (68.8) | 0.031 |
Table 2 Multivariate analysis of factors associated with mortality
| Multivariate analysis | ||
| Factor | HR (95%CI) | P value |
| Intervention vs controls | 0.4 (0.2-0.82) | 0.012 |
| Age | 1.01 (0.99-1.04) | 0.503 |
| Female gender | 1.2 (0.6-2.4) | 0.605 |
| Etiology of cirrhosis | ||
| EtOH vs HCV | 0.72 (0.29-1.8) | 0.48 |
| NAFLD vs HCV | 0.41 (0.24-2.1) | 0.088 |
| MELD score (for every 1 unit increment) | 1.05 (1.01-1.1) | 0.024 |
| Index hospitalization length of stay (for every 1 d increment) | 0.99 (0.95-1.02) | 0.47 |
| Discharge to home with home care vs home | 1.65 (0.75-3.64) | 0.212 |
| Discharge to SNF vs home | 1.4 (0.56-3.48) | 0.47 |
Table 3 Multivariate fine and gray competing risk analysis of factors associated with readmission
| Multivariate analysis | ||
| Factor | HR (95%CI) | P value |
| Intervention vs controls | 0.99 (0.66-1.48) | 0.95 |
| Age | 0.99 (0.97-1.01) | 0.39 |
| Female gender | 1.36 (0.87-2.1) | 0.18 |
| Etiology of cirrhosis | ||
| EtOH vs HCV | 0.99 (0.13-7.77) | 0.99 |
| NAFLD vs HCV | 1.03 (0.51-2.54) | 0.93 |
| MELD score (for every 1 unit increment) | 1.03 (0.99-1.05) | 0.09 |
| Index hospitalization length of stay (for every 1 d increment) | 0.99 (0.97-1.02) | 0.59 |
| Discharge to home with home care vs home | 1.12 (0.69-2.01) | 0.55 |
| Discharge to SNF vs home | 0.96 (0.51-1.83) | 0.91 |
Table 4 Comparison of studies describing various interventions targeted to improve outcomes after hospital discharge in cirrhotic patients
| Ref. | Intervention type | Number of patients | Timing of intervention | Unplanned readmission rate | Mortality | |||||
| 1 mo | 3 mo | 6 mo | 1 mo | 3 mo | 6 mo | |||||
| Wigg et al[8], 2013 | Chronic disease management program | C:20 T:40 | 12 mo after discharge | C: 0.4/person/yr T: 1/person/yr | 1C: 15% 1T: 10% | |||||
| Morando et al[10], 2013 | Care management checkup model | C: 60 T: 40 | 12 mo after discharge | C: 42% T: 15% | NA | NA | 1C: 46% 1T: 23% | |||
| Tapper et al[9], 2016 | Handheld (1st phase) and electronic (2nd phase) checklists | C: 626 T: 1st: 470 2nd: 624 | Inpatient stay | C: 38% T: 1st: 35% 2nd: 27% | NA | NA | NA | C: 20% T: 1st: 15% 2nd: 21% | NA | |
| Kanwal et al[7], 2016 | Early follow up in clinic | C: 17094 T: 8123 | At discharge | C: 14% T: 15% | NA | NA | C: 5% T: 3% | NA | NA | |
| Current study | Outpatient telephonic transitional care | C: 93 T: 76 | 30 d after discharge | C: 38% T: 37% | C: 55% T: 57% | C: 62% T: 65% | C: 10% T: 5% | C: 24% T: 13% | C: 31% T: 16% | |
- Citation: Rao BB, Sobotka A, Lopez R, Romero-Marrero C, Carey W. Outpatient telephonic transitional care after hospital discharge improves survival in cirrhotic patients. World J Hepatol 2019; 11(8): 646-655
- URL: https://www.wjgnet.com/1948-5182/full/v11/i8/646.htm
- DOI: https://dx.doi.org/10.4254/wjh.v11.i8.646