Innovating acute care for liver disease through a pilot, patient-centric Hospital@Home program

PROJECT SUMMARY Chronic liver disease (CLD) is a top-ten leading cause of death in Americans, aged 25-64, and ethnic minorities. Individuals with CLD suffer from lower health-related quality of life (HRQOL), disability and place a burden on their family caregivers. As individuals progress to end-stage liver disease, health-care utilization (HCU) increases

exponentially, largely due to inpatient care for acute decompensations. In certain clinical scenarios, after the initial 24-48 hour period, the remaining hospital days are often used to meet lower acuity needs such as continued administration of IV medications, titration of medications and/or daily lab monitoring prior to transition

to outpatient care. This latter period reflects an opportunity to improve HCU in CLD patients by addressing unmet needs within the home environment, reducing hospitalization-related complications, refining the transition to outpatient care, and increasing the healthcare system’s capacity by shortening the length of initial

hospitalizations and reducing rehospitalizations. Hospital at Home (H@H) is an emerging model of home-based care, designed to extend traditional, inpatient hospital care which may address these needs. Through H@H, acute medical care services as well as ancillary care such as rehabilitation therapy can be delivered in the home.

Prior studies have reported success with implementing this model in terms of clinical and economic efficacy as well as feasibility. Importantly, the model demonstrated greater satisfaction with care from patients, their family members, and their providers. Since November 2020, Centers for Medicare and Medicaid Services has provided

a waiver for H@H services in response to the public health emergency resulting in a sudden rise in the prevalence of H@H programs around the country. As an early adopter, Indiana University Health (IUH) introduced a H@H program to increase hospital capacity. The model at IUH successfully managed patients with

moderate COVID-19 infection, leading to an expansion in 2022 to include management of common infections and heart failure. As a next step in expansion, the IUH H@H team is partnering with PI and the IUH Hepatology team to manage select patients with CLD. The overall goal of this proposal is to assess whether IUH’s H@H

program represents a novel care delivery model in cirrhosis that is safe, improves patient and caregiver experience as well as reduces HCU in the high-risk, CLD population. To achieve this goal, we propose a pilot, prospective observational study of 30 individuals who receive care for their liver disease-related admission

through IUH’s H@H program with two specific aims. Specific Aim 1 is to assess the (1) feasibility, (2) safety, (3) patient reported outcomes and (4) impact on healthcare utilization associated with expanding IUH’s H@H program in the CLD population. Specific Aim 2 is to determine patient and caregiver acceptability of completing

care of acute exacerbations of CLD using IUH’s H@H program and elicit patient- and caregiver-centric revisions of the H@H program using human-centered design methodology.