Review for 10.1186/s12876-023-02986-y (2023)

Title: A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-
related unplanned readmissions and improved survival
Version: 1 Date: 25 Aug 2023
Reviewer's report:
This is a description of Care Coordination of Liver Disease (CCoLD) pilot, a nurse-led cirrhosis
clinic in Western Sydney. A total of 89 patients went through the pilot program vs standard care
with 3 months of follow up.
Patients hospitalized with cirrhosis complicatios had a 30 min nurse led home visit within 7 days
of hospital discharge. Standard care comparator was a nu
There were demonstrated differences  liver-related readmissions (2.08% for intervention cohort
vs 12.2% for control cohort, p<0.01), and mortality at 30 days (0% for intervention cohort vs
7.3% for control cohort, p=0.03). Unplanned liver-related readmissions were 10.41% for the
intervention cohort vs 19.5% for the control cohort (p=0.115).
The clinical problem is important and the manuscript is generally well-written. It is not clear
whether this was a prospective randomized trial or whether patients in the pilot was matched
post-hoc. Details of the interventions and outcome definitions need further clarity. The number
of background references should be increased
I have questions and clarifications to strengthen the manuscript:
1. Abstract – it should be made clear that a total of 89 patients were randomized to cCOLD vs
usual care if this was the case.
2. Abstract – would make sure to emphasize that the intervention included home visits (if this
is what happened) as this appears later in methods
3. Introduction and Discussion where relevant – site papers that describe cirrhosis day hospital,
care coordination, and that early post discharge care is associated with improved outcomes.
a.  doi: 10.1016/j.jhep.2013.03.010. Epub 2013 Mar 21
b. PMID: 37219845
c. PMID: 26991920
d. PMID: 37219845
4. Methods: exclusion of patients with characteristics that place them at high risk for readmission
is a major limitation (alcohol use disorder, TIPS within 6 months, recent antiviral therapy).
Should be mentioned in the discussion.
5. Methods: was there prospective randomization of patients? Who or what determined
assignment to cCOLD or usual care?
6. Methods: was the study registered as a clinical trial? Is there a clinical trial number?
7. Methods: usual care should be described in more detail
8. Methods: the outcomes and statistics section should be broken out into 2 sections. All study
outcomes should be defined clearly – outcomes of cost effectiveness and resource use are
currently not well-defined
9. Was there a power analysis conducted before starting the study/
10. Methods: it is not clear whether this “matching” is the same as randomization. Were patients
prospectively assigned to intervention vs. control or were matched analyses done post-hoc?
Please clarify.
11. Methods: Figure 1 generally describes components of the intervention. However, how were
all these intervention components actually operationalized. Would recommend describing this
in the text.
12. Results: Table 1 – no data is provided on charlssonn comorbidities that were used for
matching, MELD-NA components should be included in the table. Table S1 should be combined
with Table 1.
13. Results: Figure 4 is probably better as Figure 1
14. Results/Methods: how was an unplanned readmission defined?
15. Results: the program was “well-received”. Were there any surveys done to measure patient
satisfaction? Was satisfaction and outcome?
16. Discussion – recommended a few references for the introduction that are also relevant here.
Would do a more thorough literature search and provide a more in depth discussion of how this
program fits into other work.