studies

474A AASLD ABSTRACTS HEPATOLOGY, October, 2015
are needed. Our process demonstrated the possibility that a
reduction in readmission rates could be achieved with a multifaceted
process that incorporates nurse directed education with
performance feedback and telephonic symptom assessment,
coupled with rapid provider communications. A larger study
will be required to confirm these findings.
Disclosures:
Simona Rossi - Consulting: BMS; Speaking and Teaching: gilead
Eyob L. Feyssa - Advisory Committees or Review Panels: Gilead; Grant/Research
Support: J&J, BMS, Abbot, Salix, Conatus, Cumberland, Merck; Speaking and
Teaching: Gilead, BMS, Abbvie
The following authors have nothing to disclose: Manisha Verma, Catherine Reynolds,
Dee Morrison, June Smith, Cindy Mcglone, Victor J. Navarro
531
Thirty-day Readmission Following Liver Transplant in
Medicare Beneficiaries – Incidence, Etiology, Outcomes,
and Cost
Lorna M. Dove 1 , Mary Jo Braid-Forbes 2 , Kevin F. Forbes 2 , Daniel
J. Lerner 3 ; 1 Internal Medicine, Columbia University College of
Physicians and Surgeons, New York, NY; 2 Braide-Forbes Health
Research, Silver Spring, MD; 3 Health Sciences West, Scarsdale,
NY
BACKGROUND: Readmission of Medicare beneficiaries (MBs)
within 30 days of hospitalization (30dRA) is considered a
quality indicator, and it increases the total amount of annual
Medicare spending. In 2015 the Centers for Medicare and
Medicaid Services (CMS) can reduce reimbursements by up to
3% for hospitals with high 30dRA rates for specific conditions.
More than one-third of liver transplant (LT) recipients in the US
are MBs, but little is known about 30dRA following LT in this
group. PURPOSE: The purpose of this study is to define the
incidence, etiology, outcomes, and cost of 30dRA following
LT in adult MBs. METHODS: A total of 1,359 adult Medicare
fee-for-service beneficiaries who underwent LT and survived
to discharge in 2011 were identified and used to define the
incidence of 30dRA following LT, and the principal diagnoses,
outcomes, patient characteristics, and inpatient costs associated
with those 30dRA. RESULTS: The incidence of 30dRA
following LT in MBs was 37%. This is substantially higher than
published 30dRA rates for MBs following acute myocardial
infarction (AMI), heart failure (HF), pneumonia, and coronary
artery bypass grafting (CABG). The most common principal
diagnoses for 30dRAs were complications of a device implant
or graft (21.5%) or medical or surgical care (12.9%), fluid and
electrolyte disorders (5.4%), septicemia (4.4%), and acute/
unspecified renal failure (4.0%). The most common procedures
at readmission were transfusion of blood products (11.7%),
non-cardiac vascular catheterization (8.4%), and non-operating
room GI procedures (8.2%). Factors associated with
increased risk of readmission after risk adjustment were being
Medicaid eligible (dual eligible) (OR 1.64, 95% CI [1.26-
2.13]), and having renal failure at the time of transplantation
(OR 1.44 95%CI [1.06-1.94]). The association of dual-eligibility
with 30dRA is important because more than one-third
of the MBs who underwent LT were dual-eligible, significantly
more than in the general Medicare population. The mean cost
of a 30dRA was $21,054. One year after hospitalization
for LT, patients who had a 30dRA had significantly reduced
survival (11.7% vs. 3.7%; P=0.01), and their total inpatient
care costs were 34% higher, compared to patients without a
30dRA ($252,985 vs. $189,352). CONCLUSIONS: In MBs,
the 30dRA rate following LT was 37%, higher than reported
for AMI, HF, pneumonia, or CABG. Complications were the
most common cause for 30dRA. Patients with a 30dRA had
decreased survival and increased inpatient costs at one year.
Future research should focus on strategies to reduce complications
from LT, and reduce 30dRA in patients at increased risk.
Disclosures:
The following authors have nothing to disclose: Lorna M. Dove, Mary Jo Braid-
Forbes, Kevin F. Forbes, Daniel J. Lerner
532
Epidemiology and survival in patients with cirrhosis in a
large commercial insurer database
Steven J. Scaglione 1,3 , Leanne N. Metcalfe 2 , Stephanie Kliethermes
3 , Rebecca Tsang 1 , Vik Goyal 4 , Allyce Caines 4 , Shaham
Mumtaz 4 , Amy Luke 3 , Scott Cotler 1 ; 1 Hepatology, Loyola University
Medical Center, Maywood, IL; 2 Enterprise Clinical Analytics,
Health Care Services Corporation, Chicago, IL; 3 Preventive Medicine,
Loyola University Medical Center, Maywood, IL; 4 Internal
Medicine, Loyola University Medical Center, Maywood, IL
Background: There are limited data regarding the epidemiology
of cirrhosis in the general population (Scaglione, Volk,
2014). We analyzed a large commercial insurance provider
database to investigate the prevalence of cirrhosis, differences
in survival in compensated versus decompensated cirrhosis,
and differences in survival between NASH and HCV-related
cirrhosis with and without diabetes. Methods: Retrospective
matched case-control analysis estimating the prevalence in
clinical-demographic, risk factors and survival associated with
cirrhosis from Sept 2008-Aug 2013 by Health Care Services
Corporation (HCSC), a commercial insurer providing healthcare
coverage in 5 states. Cirrhosis was defined as ICD-9 code
571.2, 571.5, or 571.6. The index date was the date of the
first cirrhosis ICD-9-code occurring in the database after the
first 6 months of continuous enrollment. Decompensated cirrhosis
was defined as ICD-9 571.2, 571.5, or 571.6 AND a
2nd diagnostic code for decompensation (any ICD-9: 070.44,
070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3,
572.4, 782.4, 789.59). Compensated cirrhosis is defined
as those with ICD-9 571.2, 571.5, 571.6 and lacking ICD-9
for decompensation as above. HCV Cirrhosis was defined by
diagnostic codes for chronic HCV (ICD-9: 070.54 or 070.70)
on at least two occasions a month or more apart. NAFLD
was defined as by ICD-9 571.8 at any time in the absence
of codes for other causes of liver disease. Results: During the
study period, there were 18,202 persons with cirrhosis among
3,478,093 enrollees, yielding a prevalence of 0.52%. Cirrhotics
were older (55.6 vs 43.7,p