A Prospective Multimodal Education Intervention for Providers Does Not Increase Hepatic Encephalopathy Treatment...

Area of Science:

• Hepatology
• Gastroenterology
• Medical Education

Background:

• Hepatic encephalopathy (HE) hospitalizations are often preventable, yet many patients do not receive timely medical treatment.
• Identifying and overcoming barriers to HE treatment is crucial for improving patient outcomes.

Purpose of the Study:

• To implement and evaluate a multimodal education intervention (MMEI) aimed at increasing treatment rates for hepatic encephalopathy (HE).
• To analyze trends in HE treatment, identify predictors of treatment receipt, and assess the impact of treatment on hospitalization outcomes.

Main Methods:

• A prospective, single-center cohort study was conducted over 30 months, comparing a 15-month control period (pre-MMEI) with a 15-month intervention period (MMEI).
• The MMEI incorporated prior authorization resources, an electronic order set, and in-person provider education.
• Treatment was defined as receiving lactulose, rifaximin, or combination therapy; rates were compared using logistic regression.

Main Results:

• The MMEI did not significantly increase the overall odds of receiving any drug treatment for HE (p=0.03).
• Combination therapy rates remained unchanged post-MMEI (p=0.32).
• Predictors for receiving treatment included alcohol-related/cryptogenic cirrhosis, ascites, and portal hypertension; autoimmune cirrhosis was a predictor for *not* receiving treatment. Patients seen by internal medicine or who were intoxicated were less likely to receive rifaximin. Any treatment was associated with higher 30-day readmission for liver disease (p<0.001).

Conclusions:

• The implemented multimodal education intervention failed to improve HE treatment rates.
• Further research into alternative strategies is necessary to effectively address barriers and enhance medical treatment for patients with hepatic encephalopathy.