Harvard Medical School, Boston, MA, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Dig Dis Sci. 2024 May;69(5):1669-1673. doi: 10.1007/s10620-024-08361-5. Epub 2024 Mar 11.
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.
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.
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.
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.
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.
肝硬化患者的 30 天再入院率超过 30%。需要新的护理模式来降低与肝硬化护理相关的医疗保健成本和利用率。一种这样的模式是家庭医院（HH），它提供家庭层面的住院级护理。目前，支持肝硬化患者使用 HH 的证据有限。
本研究的目的是描述在一项两地点临床试验中接受家庭住院级护理的肝硬化患者的特征，并描述他们所接受的护理。次要目的包括描述他们的结局，包括不良事件、再入院和死亡率。
我们确定了所有在 2017 年至 2022 年期间作为两项临床试验的一部分接受 HH 的肝硬化患者。HH 服务包括每日临床医生访问、静脉和口服药物、连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学数据，并分析了 HH 入住情况，包括干预措施、结局、不良事件和随访。
在研究期间，有 22 名肝硬化患者（45%为西班牙裔；50%英语水平有限，中位 MELD-Na 为 12）接受 HH。干预措施包括实验室化学检查（82%）、静脉内药物（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。有 2 名患者（9%）发生不良事件（AKI）。没有患者需要升级治疗；9%的患者在 30 天内再次入院。
在这项两地点研究中，HH 对肝硬化患者是可行的，有望成为一种肝病治疗模式。需要进一步开展随机试验来评估 HH 对肝硬化患者的疗效。
