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Principal Investigator: Archita P. Desai
Organization: INDIANA UNIVERSITY INDIANAPOLIS
Fiscal Year: 2024
Award: $129,301
Funding agency: National Institute of Diabetes and Digestive and Kidney Diseases
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.
Terms: <Active Follow-up><Acute><Address><Admission><Admission activity><Ambulatory Care><American><Burden on their caregivers><COVID-19 infection><COVID-19 virus infection><COVID19 infection><Care Givers><Caregiver Burden><Caregivers><Caring><Cause of Death><Centers for Medicare and Medicaid Services><Cirrhosis><Client satisfaction><Clinical><Collection><Country><Data Collection><Drugs><Economics><Enrollment><Ensure><Family Care Giver><Family Caregiver><Family member><Feedback><Foundations><Future><Goals><Health><Health Care Financing Administration><Health Care Systems><Health Care Utilization><Healthcare Delivery><Healthcare Systems><Heart failure><Hepatic Disorder><Hepatology><Home><Home Care><Home environment><Hospital Admission><Hospital Design><Hospitalization><Hospitals><Hour><Indiana><Individual><Infection><Inpatients><Interview><Length><Length of Stay><Liver diseases><Measurement><Measures><Medical><Medical Rehabilitation><Medication><Methodology><Modeling><Monitor><Number of Days in Hospital><Observation research><Observation study><Observational Study><Observational research><Outpatient Care><Participant><Patient Outcomes Assessments><Patient Reported Measures><Patient Reported Outcomes><Patient Satisfaction><Patient Selection><Patients><Pharmaceutical Preparations><Pilot Projects><Population><Prevalence><Procedures><Prospective Studies><Provider><QOL><Quality of life><Randomized, Controlled Trials><Rehabilitation><Rehabilitation therapy><Reporting><Research Design><SARS-CoV-2 infection><SARS-CoV2 infection><Safety><Science><Service delivery model><Service model><Services><Severe acute respiratory syndrome coronavirus 2 infection><Solid><Structure><Study Type><Technology><Titrations><United States Centers for Medicare and Medicaid Services><United States Health Care Financing Administration><Universities><Visit><active followup><acute care><aged><ancillary care><burden in caregivers><burden of their caregivers><burden on caregivers><cardiac failure><care delivery model><care services><care systems><chronic hepatic disease><chronic hepatic disorder><chronic liver disease><chronic liver disorder><cirrhotic><coronavirus disease 2019 infection><design><designing><disability><drug/agent><economic><efficacy trial><end stage liver disease><end stage liver failure><enroll><ethnic minority><experience><follow up><follow-up><followed up><followup><health and care delivery><health care delivery><health care delivery model><health care service use><health care service utilization><health delivery systems><health related quality of life><health services delivery><healthcare burden><healthcare delivery model><healthcare service use><healthcare service utilization><healthcare utilization><hepatic disease><hepatopathy><high risk><high risk group><high risk individual><high risk people><high risk population><homes><hospital care><hospital days><hospital length of stay><hospital re-admission><hospital readmission><hospital stay><human centered design><improved><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><innovate><innovation><innovative><inpatient care><inpatient service><liver disorder><meeting><meetings><mortality><novel><outpatient treatment><patient centered><patient home care><patient homecare><patient oriented><pilot study><programs><prospective><public health emergency><randomized control trial><re-admission><re-hospitalization><readmission><recruit><rehab therapy><rehabilitative><rehabilitative therapy><rehospitalization><response><satisfaction><study design><success><waiver>