Background

Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients.

Aims

The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality.

Methods

We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up.

Results

22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7 days (IQR 4–12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30 days.

Conclusions

In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.

中文翻译：

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肝硬化患者的医院级家庭护理

背景

肝硬化患者30天再入院率超过30%。需要新的护理提供模式来降低与肝硬化护理相关的医疗成本和利用率。其中一种模式是家庭医院 (HH)，它在家中提供住院级别的护理。目前支持肝硬化患者 HH 的证据有限。

目标

本研究的目的是描述在两中心临床试验中在家接受医院级护理的肝硬化患者的特征，并描述他们所接受的护理。次要目标包括描述其结果，包括不良事件、再入院和死亡率。

方法

我们确定了 2017 年至 2022 年间参加 HH 两中心临床试验的所有肝硬化患者。HH 服务包括每日临床医生就诊、静脉注射和口服药物、持续生命体征监测和远程医疗专家咨询。我们收集了社会人口统计数据并分析了 HH 停留情况，包括干预措施、结果、不良事件和随访。

结果

研究期间，22 名肝硬化患者（45% 为西班牙裔；50% 英语水平有限，MELD-Na 中位数 12）参加了 HH。干预措施包括实验室化学（82%）、静脉注射药物（77%）、专家咨询（23%）和高级诊断/程序（23%）。中位住院时间为 7 天（IQR 4-12）；节省了 186 个床位日。两名患者 (9%) 出现不良事件 (AKI)。没有患者需要升级护理；9% 在 30 天内重新入院。

结论

在这项两中心研究中，HH 对于肝硬化患者来说是可行的，有望成为肝病治疗模型。未来需要随机试验来进一步评估 HH 对肝硬化患者的疗效。