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Efficacy of a chronic disease management model for patients with chronic liver failure

Alan J Wigg1, Rosemary McCormick, Rachel Wundke

  • 1Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, Australia. alan.wigg@health.sa.gov.au

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|February 5, 2013
PubMed

Insights

Chronic disease management (CDM) for chronic liver failure (CLF) patients improved outpatient attendance and quality of care but did not reduce hospitalizations or improve quality of life. Further research is needed to confirm these findings.

Area of Science:

  • Hepatology
  • Chronic disease management
  • Clinical trial methodology

Background:

  • Chronic liver failure (CLF) poses significant economic burdens.
  • Chronic disease management (CDM) programs are successful in other chronic conditions.
  • No randomized controlled trials (RCTs) have evaluated CDM for CLF patients.

Purpose of the Study:

  • To investigate the efficacy of CDM programs for CLF patients.
  • To assess the impact of CDM on hospital use, outpatient attendance, disease severity, quality of life, and quality of care.

Main Methods:

  • A prospective, controlled trial involving 60 CLF patients.
  • Patients were randomized to either an intervention group (n=40) or usual care group (n=20).
  • The 12-month intervention included delivery system redesign, self-management support, decision support, and clinical information systems.

Main Results:

  • CDM did not significantly reduce liver-related hospital bed days (17.8 vs 11.0 bed days/person/year).
  • Patients receiving CDM showed a 30% higher rate of outpatient care attendance (IRR, 1.3; P = .004).
  • Significant improvements were observed in quality of care, including adherence to screening, vaccination guidelines, and transplant referrals (P < .05).

Conclusions:

  • CDM for CLF patients increased outpatient attendance and quality of care.
  • CDM did not reduce hospital admission rates, disease severity, or improve quality of life.
  • Larger trials with longer follow-up are necessary to validate findings and assess cost-effectiveness.
Abstract

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