Abstract
Introduction
Patients with liver disease have high rates of early hospital readmission, but there
are no studies of effective, scalable interventions to reduce this risk. In this study,
we examined the impact of a Physician Assistant (PA)-led post-discharge Transitional
Liver Clinic (TLC) on hospital readmissions.
Methods
We performed a cohort study of all adults seen by a hepatologist during admission
to a tertiary care center in 2019 (excluding transplant patients). We compared those
who attended the TLC with those who did not, with respect to 30-day readmission and
mortality. Propensity score-adjusted modeling was used to control for confounding.
Results
Of 498 patients, 98 were seen in the TLC; 35% had alcoholic liver disease and 58%
had cirrhosis. Attendees were similar to non-attendees with respect to demographics,
liver disease characteristics and severity, comorbidities, and discharge disposition.
Thirty-day cumulative incidence of readmissions was 12% in TLC attendees, compared
with 22% in non-attendees (P = .02), while 30-day mortality was similar (2.0% vs 4.3%; P = .29). In a model using propensity score adjustment, TLC attendance remained associated
with reduced readmissions (subhazard ratio 0.52; 95% confidence interval, 0.27-0.997;
P = .049). The effect of TLC was greater in women compared with men (P = .07) and in those without chronic kidney disease (P = .02), but there were no differences across other subgroups.
Conclusions
Patients with liver disease seen in a PA-led TLC may have a significant reduction
in the 30-day readmission rate. Randomized trials are needed to establish the efficacy
of PA-led post-discharge transitional care for this population.
Keywords
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Article Info
Publication History
Published online: October 13, 2021
Footnotes
Funding: Research reported in this publication was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23 DK123408. The work was independent of the funding.
Conflicts of Interest: The authors declare no conflicts of interest. NC has several consulting agreements with and receives grant support from pharmaceutical companies, but they are unrelated to this paper.
Authorship: Study concept and design: LY, RV, ESO; Data acquisition: LY, HH, LC, AM; Interpretation: LY, FP, RV, HH, LC, APD, AM, NC, ESO; Data analysis: FP; Drafting the manuscript: LY, FP, ESO; Critical revision of the manuscript: LY, FP, RV, HH, LC, APD, AM, NC, ESO; Approval of the final draft submitted: LY, FP, RV, HH, LC, APD, AM, NC, ESO.
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