Coordinated care for patients with cirrhosis: fewer liver-related emergency admissions and improved survival

Objectives: To compare the incidence of liver-related emergency admissions and survival of patients after hospitalisation for decompensated cirrhosis at two major hospitals, one applying a coordinated chronic disease management model (U1), the other standard care (U2); to examine predictors of mortality for these patients. 

Design: Retrospective observational cohort study. 

Setting: Two major tertiary hospitals in an Australian capital city.

Participants: Patients admitted with a diagnosis of decompensated cirrhosis during October 2013 e October 2014, identified on the basis of International Classification of Diseases (ICD-10) codes.

Main outcome measures: Incident rates of liver-related emergency admissions; survival (to 3 years). 

Results: Sixty-nine patients from U1 and 54 from U2 were eligible for inclusion; the median follow-up time was 530 days (range, 21e1105 days). The incidence of liver-related emergency admissions was lower for U1 (mean, 1.14 admissions per personyear; 95% CI, 0.95e1.36) than for U2 (mean, 1.55 admissions per person-year; 95% CI, 1.28e1.85; adjusted incidence rate ratio [U1 v U2], 0.52; 95% CI, 0.28e0.98; P ¼ 0.042). The adjusted probabilities of transplantation-free survival at 3 years were 67.7% (U1) and 37.2% (U2) (P ¼ 0.009). Independent predictors of reduced transplantation-free free survival were Charlson comorbidity index score (per point: hazard ratio [HR], 1.27; 95% CI, 1.05e1.54, P ¼ 0.014), liver-related emergency admissions within 90 days of discharge (HR, 3.60; 95% CI, 1.87e6.92; P < 0.001), and unit (U2 v U1: HR, 2.54, 95% CI, 1.26e5.09; P ¼ 0.009). 

Conclusions: A coordinated care model for managing patients with decompensated cirrhosis was associated with improved survival and fewer liver-related emergency admissions than standard care.