Telemedicine Reduces Cirrhosis-Related Hospital Readmissions in Patients With End Stage Liver Disease

Document Type

Article

Abstract

INTRODUCTION:

Telemedicine offers a means to overcome barriers of access to care, improve patient satisfaction, reduce hospitalizations, and simplify communications between patients and providers. Studies involving telemedicine and its use in patients with cirrhosis have been limited. We aim to determine if patients with end stage liver disease (ESLD) had decreased hospital readmission rates at 30 days and 90 days when provided access to telemedicine services.

METHODS:

This is a single center retrospective analysis in a tertiary care, liver transplant center comparing the all-cause readmission rates of ESLD patients who received a remote patient monitoring system versus prior readmission rates. We identified all adult patients with cirrhosis who received the Vivify Health© Platform for remote patient monitoring after an inpatient hospitalization between 1/1/2018 and 9/22/2019. This service included a visit with a provider through video conferencing and symptom monitoring once a week for a planned 30 days. Readmission rates within 30 and 90 days of the initial hospitalization were obtained. Non English speaking patients were excluded.

RESULTS:

A total of 40 patients were involved in the analysis. The 30- and 90-day rates of all-cause hospital readmission in patients using a telemedicine platform between 1/1/2018 and 9/22/2019 was 17.5% and 25.0% respectively. The readmission rate in 30 days for patients with ESLD at our center in 2017 prior to the implementation of the program was 40%. The average MELD-Na score for patients with no readmissions within 90 days and patients with readmissions within 90 days were similar at 20 and 21 respectively. The most common reason for readmission was hepatic encephalopathy.

CONCLUSION:

Patients who received the telemedicine system had lower 30-day all-cause readmission rates compared to readmission rates prior to the implementation of this system. Lower rates of readmission alone may not indicate an improvement of quality of care because patients may require hospitalizations to optimize their disease. In fact, patients using telemedicine may lead to improved detection of symptoms and appropriate admissions. Future studies must clarify those aspects of telemedicine that are most effective in the reduction in readmissions. Further barometers to quantify the effectiveness of telemedicine are improvement of quality-of-care indicators and mortality rates. This study further highlights the benefits of telemedicine in reducing hospitalizations in cirrhotic patients.

First Page

S572

DOI

10.14309/01.ajg.0000706612.10479.a1

Publication Date

10-1-2020

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