Related Experiment Video
Updated: Aug 4, 2025
"Liver-on-a-Chip" Cultures of Primary Hepatocytes and Kupffer Cells for Hepatitis B Virus Infection
Published on: February 19, 2019
Quantifying days at home in patients with cirrhosis: A national cohort study
Hirsh Elhence1, Jennifer L Dodge2,3, Albert J Farias2
1Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Patients with cirrhosis experience significantly reduced Days at Home (DAH), often losing up to two months annually due to liver decompensation. This metric highlights extensive post-acute and emergency care use in cirrhosis patients.
Area of Science:
- Hepatology
- Health Services Research
- Patient-Reported Outcomes
Background:
- Days at Home (DAH) is a patient-centric metric assessing annual healthcare utilization beyond hospitalizations.
- Understanding DAH in cirrhosis is crucial for evaluating patient well-being and healthcare system efficiency.
- Previous studies have not comprehensively analyzed DAH in patients with cirrhosis.
Purpose of the Study:
- To quantify Days at Home (DAH) in patients with cirrhosis.
- To identify clinical factors associated with DAH variations in this population.
- To compare DAH in cirrhosis patients with other chronic conditions.
Main Methods:
- Utilized a national claims database (Optum) from 2014-2018 to calculate DAH.
- Included 63,477 patients with cirrhosis and a control group from over 20 million patients.
- Employed mixed-effects linear regression to analyze factors associated with DAH.
Main Results:
- Patients with cirrhosis had lower age-adjusted mean DAH (335.1 days) compared to those without (360.1 days).
- Decompensated cirrhosis was associated with increased post-acute, emergency, and observation days (15.2 days) and hospitalization days (13.8 days).
- Hepatic encephalopathy and ascites significantly decreased DAH, while variceal bleeding showed no association.
Conclusions:
- Cirrhosis patients incur substantial healthcare utilization in post-acute, emergency, and observation settings, comparable to hospitalizations.
- Liver decompensation can lead to an annual loss of up to two months of DAH.
- DAH presents a valuable metric for assessing patient outcomes and healthcare system performance in cirrhosis management.
Background And Aims:
Days at home (DAH) is a patient-centric metric developed by the Medicare Payment Advisory Commission, capturing annual health care use, including and beyond hospitalizations and mortality. We quantified DAH and assessed factors associated with DAH differences among patients with cirrhosis.
Approach And Results:
Using a national claims database (Optum) between 2014 and 2018, we calculated DAH (365 minus mortality, inpatient, observation, postacute, and emergency department days). Among 20,776,597 patients, 63,477 had cirrhosis (median age, 66, 52% males, and 63% non-Hispanic White). Age-adjusted mean DAH for cirrhosis was 335.1 days (95% CI: 335.0 to 335.2) vs 360.1 (95% CI: 360.1 to 360.1) without cirrhosis. In mixed-effects linear regression, adjusted for demographic and clinical characteristics, patients with decompensated cirrhosis spent 15.2 days (95% CI: 14.4 to 15.8) in postacute, emergency, and observation settings and 13.8 days (95% CI: 13.5 to 14.0) hospitalized. Hepatic encephalopathy (-29.2 d, 95% CI: -30.4 to -28.0), ascites (-34.6 d, 95% CI: -35.3 to -33.9), and combined ascites and hepatic encephalopathy (-63.8 d, 95% CI: -65.0 to -62.6) were associated with decreased DAH. Variceal bleeding was not associated with a change in DAH (-0.2 d, 95% CI: -1.6 to +1.1). Among hospitalized patients, during the 365 days after index hospitalization, patients with cirrhosis had fewer age-adjusted DAH (272.8 d, 95% CI: 271.5 to 274.1) than congestive heart failure (288.0 d, 95% CI: 287.7 to 288.3) and chronic obstructive pulmonary disease (296.6 d, 95% CI: 296.3 to 297.0).
Conclusions:
In this national study, we found that patients with cirrhosis spend as many, if not more, cumulative days receiving postacute, emergency, and observational care, as hospitalized care. Ultimately, up to 2 months of DAH are lost annually with the onset of liver decompensation. DAH may be a useful metric for patients and health systems alike.
