telehealth intervention in cirrhotics

Conditions: Cirrhosis, Liver; Liver Diseases

Summary: this study is a randomized controlled trial comparing a simple telehealth intervention implemented after hospital discharge to standard of care, specifically looking at the number of hospital readmissions throughout the course of the study. all cirrhotic patients admitted to the hepatology service at the hospital of the university of pennsylvania will be approached and consenting patients will be randomized to one of the two arms as outlined below. patients will be followed for 90 days with daily texts and weekly phone calls. the rates of 30 and 90 day readmission as well as the days to readmission will be compared between the two study groups.

patients with cirrhosis and ascites comprise a large percentage of hospital admissions. as a large transplant center, the university of pennsylvania sees an average of 54-65 cirrhotic patients admitted to the hepatology service every month. many of these admissions are preventable and can be attributed to poor medication adherence and late detection of clinical deterioration. by introducing a telehealth intervention following hospital discharge, investigators seek to decrease the number of readmissions for these patients by encouraging and assisting with improved adherence and by regularly tracking the progression of symptoms. this interventional study will serve a dual purpose of helping both the patient and their provider. patients will obtain an extra line of communication to their providers that eases their ability to access resources and alert their providers to new symptoms. similarly, by instituting a triaged system of communication with the patient, their health team is able to offer more individualized treatment while also providing more immediate attention at the first signs of clinical deterioration. this study will determine rates of 30 and 90-day readmissions in both cohorts as a way to examine the impact of a simple telehealth intervention compared to standard of care.

Eligibility criteria:
inclusion criteria: * clinical diagnosis of cirrhosis of the liver * admitted to the hospital of the university of pennsylvania * ability to read and provide informed consent in english * ability to read and provide informed consent or surrogate present who can provide consent * possess a cell phone and willing to receive text messages. * has a surrogate who with a cell phone who is willing to receive and sent text messages for patient exclusion criteria: * inability to provide informed consent in english * inability to provide informed consent or lack of surrogate who can provide consent * non-cirrhotic * has received a liver transplant * discharged to hospice or has a disease process other than cirrhosis (i.e. severe heart disease or cancer) accounting for a high chance of mortality in the next 6 months. * advance symptoms of other disease process or too medically complex * actively using illicit substances or alcohol * no access to cell phone with texting capability * not followed at the hospital of the university of pennsylvania

Keywords: telehealth cirrhosis ascites hepatic encephalopathy readmissions preventable readmissions liver diseases variceal bleeding