Division of Gastroenterology, Hepatology and Nutrition, Richmond, VA, USA.
C.I.T.I. Corporation, Falls Church, VA, USA.
Liver Int. 2017 Dec;37(12):1843-1851. doi: 10.1111/liv.13494. Epub 2017 Jul 5.
BACKGROUND & AIMS: Readmissions are a major burden in cirrhosis. A proportion of readmissions in cirrhosis, especially because of hepatic encephalopathy (HE) could be avoided through patient and caregiver engagement. We aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study.
Cirrhotic inpatients with caregivers were enrolled and followed for 30 days post-discharge. On separately assigned devices loaded with Patient Buddy, they were trained on entering medication adherence, daily sodium intake and weights, and weekly cognitive (EncephalApp_Stroop) and fall-risk assessment and were educated regarding cirrhosis-related symptoms. These were monitored daily through a Patient Buddy loaded iPad by the clinical team. The App sent automatic alerts between patient/caregivers and clinical team regarding adherence and critical values. At 30 days, total, and HE-related admissions were analysed as well as the feasibility and feedback regarding educational values.
Forty patients and 40 caregivers were enrolled. Seventeen patients were readmitted within 30-days but none for HE. Eight potential HE-related readmissions were prevented through App-generated alerts that encouraged early outpatient interventions. Caregivers and patients were concordant in data entry but six did not complete data entries. Most respondents rated the App favourably for its educational value.
In this proof-of-concept trial, the use of Patient Buddy is feasible in recently discharged patients with cirrhosis and their caregivers. Eight HE-related readmissions were potentially avoided after the use of the App.
再入院是肝硬化患者的主要负担。肝硬化患者再入院的部分原因，尤其是肝性脑病（HE）导致的再入院，可以通过患者和护理人员的参与来避免。我们旨在通过参与和教育肝硬化住院患者及其护理人员，在一项试点研究中确定使用患者伙伴应用程序的可行性及其对 30 天再入院率的影响。
纳入并随访肝硬化住院患者及其护理人员 30 天。他们分别在装有患者伙伴的设备上接受培训，学习输入药物依从性、每日钠摄入量和体重，以及每周认知（EncephalApp_Stroop）和跌倒风险评估，并接受有关肝硬化相关症状的教育。这些信息通过临床团队装载的患者伙伴 iPad 进行日常监测。该应用程序会自动向患者/护理人员和临床团队发送有关依从性和关键值的警报。在 30 天、总再入院率和 HE 相关再入院率方面进行分析，并评估教育价值的可行性和反馈。
共纳入 40 名患者和 40 名护理人员。17 名患者在 30 天内再入院，但无一例是因 HE 再入院。通过应用程序生成的警报，有 8 例潜在的与 HE 相关的再入院得到了预防，这些警报鼓励了早期的门诊干预。护理人员和患者在数据录入方面是一致的，但有 6 人未完成数据录入。大多数受访者对该应用程序的教育价值评价较高。
在这项概念验证试验中，患者伙伴在最近出院的肝硬化患者及其护理人员中是可行的。使用该应用程序后，有 8 例与 HE 相关的再入院得到了潜在的避免。
