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This research study is evaluating a program that entails a healthcare at home intervention for people with advanced liver disease.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hepatology Hospital at Home | Experimental | Patients with advanced liver disease receive hospital-level care in the home setting |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hepatology Home Hospital | Behavioral | The Hepatology Home Hospital intervention entails the following: patient-reported symptoms and vital signs with appropriate triggers for phone calls and home visits, and regular communication with hepatology clinicians regarding care delivered at home to ensure continuity of care. |
| Measure | Description | Time Frame |
|---|---|---|
| Escalation Rate | The intervention will be deemed feasible if less than 20% of enrolled patients have escalation of care back to the inpatient (brick-and-mortar) hospital | 18 months |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Experience | To assess patient experience scores (Picker Patient Experience Questionnaire, Global satisfaction questionnaire) at discharge from HepHospital | Up to 90 days |
| Adverse Event Reporting |
| Measure | Description | Time Frame |
|---|---|---|
| Decline Rate | We will assess rates that patients decline to enroll in HepHospital | 18 months |
| Quality of life (PROMIS-29 +2) | Change in participants' QOL as measured by the PROMIS-29+2 scale throughout the study. |
Inclusion Criteria:
Adult patients ≥ 18 years old with diagnosis of cirrhosis based on histology, radiology, and/or elastography presenting to the emergency department or inpatient general medicine service
Patients must have one of the following:
Exclusion Criteria: All existing MGB home hospital criteria apply, with the following taking precedent for this specific condition
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nneka Ufere, MD, MSCE | Contact | 617-643-3408 | nufere@partners.org | |
| William Munroe, BA | Contact | 617- 726-0161 | wlmunroe@mgh.harvard.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Massachusetts General Hospital | Recruiting | Boston | Massachusetts | 02114 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31842232 | Background | Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020 Jan 21;172(2):77-85. doi: 10.7326/M19-0600. Epub 2019 Dec 17. | |
| 38466464 | Background | Kahn-Boesel O, Mitchell H, Li L, Zhu E, El-Jawahri A, Levine D, Ufere NN. Hospital-Level Care at Home for Patients with Cirrhosis. Dig Dis Sci. 2024 May;69(5):1669-1673. doi: 10.1007/s10620-024-08361-5. Epub 2024 Mar 11. |
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We will assess rates of adverse events (acute kidney injury, falls, delirium, deep vein thrombosis/pulmonary embolism, escalation of care back to an inpatient hospital setting for at least 1 overnight stay, and death) for patient enrolled in HepHospital
| Up to 90 days |
| Acceptability | Qualitative acceptability ratings from patients, caregivers, and clinicians obtained via exit individual interviews regarding acceptability (i.e. usefulness, effectiveness, and relevance of the intervention) from patients, family caregivers, and clinicians. | 18 months |
| Baseline to post-discharge (+5 business day window) and 30-days (+10 business day window) post-discharge |
| Change in symptom Burden (Edmonton Symptom Assessment System-revised, ESAS-r) | Change in participants' symptom burden as measured by the ESAS-r throughout the study. | Baseline to post-discharge (+5 business day window) and 30-days (+10 business day window) post-discharge |
| Unplanned readmission(s) after index hospitalization | We will assess # of unplanned readmission(s) at 30- and 90-days post-discharge | Day of discharge to 30-days and 90-days post-discharge |
| Emergency Department Visit(s) after index hospitalization | We will assess # of emergency department visit(s) at 30- and 90-days post-discharge | Day of discharge to 30-days and 90-days post-discharge |
| Total costs of care | To assess total costs of the acute care episode | 18 months |
| Massachusetts General Hospital | Recruiting | Boston | Massachusetts | 02114 | United States |
| ID | Term |
|---|---|
| D005355 | Fibrosis |
| D058625 | End Stage Liver Disease |
| D008103 | Liver Cirrhosis |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D017093 | Liver Failure |
| D048550 | Hepatic Insufficiency |
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
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