studies

918A AASLD ABSTRACTS HEPATOLOGY, October, 2015
1451
The Attention-to-Burden Index (ABI): a New Tool that
Reveals Profound Disparities between Research Attention
and Disease Burden among Liver Diseases.
Nambi J. Ndugga 1 , Teisha G. Lightbourne 2 , Kavon Javaherian 2 ,
Neha Verma 2 , Eric S. Orman 3 , David Pesci 2 , Ramon Bataller 4,2 ;
1 Center for Gastrointestinal Biology and Disease, University of
North Carolina at Chapel Hill School of Medicine, Chapel Hill,
NC; 2 Nutrition, University of North Carolina at Chapel Hill, Chapel
Hill, NC; 3 University of North Carolina at Chapel Hill, Chapel Hill,
NC; 4 Medicine, University of North Carolina at Chapel Hill School
of Medicine, Chapel Hill, NC
Rationale: In recent years, there have been great advances
in the management of HBV and HCV. Conversely, there are
no approved therapies for fatty liver diseases (NAFLD and
ALD). We hypothesize that these unequal advances are due
to disparities in the research attention surrounding different
liver diseases. Methods: To test this hypothesis, we developed
the Attention-to-Burden Index (ABI), a comprehensive tool comprised
of main research activities, and an estimate of disease
burden for the main types of liver diseases: HCV, HBV, ALD,
NAFLD. A systematic study of the research attention was carried
out for the years 2010-2015 on these 4 liver diseases. The
mean research attention for each liver disease was calculated
from 5 different levels: reference in the two major annual liver
meetings (AASLD and EASL), number of drugs in the pipeline of
38 major pharmaceutical companies, funded grants (USA and
EU), ongoing clinical trials (ClinicalTrials.gov) and scientific
publications (PubMed). The mean disease burden was calculated
from the following parameters: hospitalization costs in
USA, etiology of liver transplantation in USA and Europe, etiology
of cirrhosis, and etiology of liver fibrosis. The ABI for each
liver disease was calculated as the mean attention divided by
the mean disease burden. Results: The research attention in
both AASLD and EASL meetings to the main liver diseases was
similar: HCV (55 and 54% of total attention, respectively), HBV
(26 and 26%), NAFLD (13 and 15%), and ALD (6 and 4%).
The number of drugs in the pipeline with specific indications
for liver diseases was: 13 for HCV, 4 for HBV, 3 for NAFLD,
1 for ALD. The percentage of funded grants in the US and EU
was: HCV (54 and 62% of total grants, respectively), HBV
(24 and 33%), NAFLD (17 and 5%), and ALD (5 and 1%).
A similar pattern of research attention was found in ongoing
clinical trials and scientific publications. The calculated overall
burden for the main liver disease was 34% for HCV, 4% for
HBV, 37% for ALD and 24% for NAFLD. When comparing the
ratio between the overall research attention and the disease
burden of main liver diseases, we found striking differences.
The calculated ABI for HCV and HBV revealed a 1 and 7-fold
over-attention, respectively, while NAFLD and ALD received an
infra-attention of 2 and 8-fold. Conclusions: The ABI reveals disparities
between research attention and disease burden among
liver diseases, with a clear over-attention to viral hepatitis compared
to fatty liver diseases. Notably, the attention to ALD is
minimal. There is a critical need to increase awareness of ALD
in the liver research community.
Disclosures:
Ramon Bataller - Advisory Committees or Review Panels: Sandhill; Consulting:
VTI, Oncozyme Pharma
The following authors have nothing to disclose: Nambi J. Ndugga, Teisha G.
Lightbourne, Kavon Javaherian, Neha Verma, Eric S. Orman, David Pesci
1452
Hospital Based Initiative to Decrease Readmission Rates
in End-Stage Liver Disease
Sheela S. Reddy 1 , Chad Gorn 2 , Stephania Dottin 2 , Ann E. Burke 1 ,
Karen Newell 2 , Karen Pine 2 , Ursula Hobbs 2 , Maria Neff 2 , Jonathan
M. Fenkel 1 , David A. Sass 1 , Steven K. Herrine 1 , Jesse M.
Civan 1 , She-Yan Wong 1 , Dina Halegoua-De Marzio 1 ; 1 Medicine,
Division of Gastroenterology and Hepatology, Thomas Jefferson
University, Philadelphia, PA; 2 Transplant Services, Thomas Jefferson
University Hospital, Philadelphia, PA
Introduction: The Hospital Readmission Reduction Program, a
part of the Affordable Care Act, requires reduced payments to
hospitals with excess readmissions, or admission to a hospital
within 30 days of discharge. This penalization is based on a
hospital’s expected readmission rate, an adjusted value of the
national average. Studies have shown a ~37% readmission
rate for patient with end stage liver disease (ESLD). Due to the
burden of ESLD readmissions at our institution, a care coordination
(CC) program was created to improve transitions of
care from the inpatient to outpatient setting. The aim of this
study is to assess whether the implementation of the CC program
reduced 30-day readmissions. Methods: Our institution
is an urban quaternary care liver transplant center performing
approximately 50 liver transplants yearly in highly competitive
UNOS Region 2. Our CC program was created February
2014, with a focus on patient education, short-term outpatient
follow-up visits, and post-discharge follow-up calls by a transplant
nurse coordinator. During inpatient admission, patients
deemed high-risk by attending hepatologists were enrolled.
High-risk was defined as cirrhotic patients admitted with fluid
overload, hepatic encephalopathy and/or renal disease requiring
hemodialysis. Once discharged, the patient was scheduled
for an office visit within 7 days and received follow-up phone
calls at 48 hours after discharge, and on days 7, 14, 21, and
30. Patients who were transplanted, transferred, or expired
before 30 days were excluded from final analysis. Results: Our
hepatology service readmission rate was 33.67% in 2013.
Since February 2014, 90 high-risk patients were identified and
enrolled in the CC program. Of these 90 high-risk patients,
30-day readmission was prevented in 37.9% of patients, but
62.1% still had at least one 30-day readmission. CC protocol
compliance was 87.5%. From October 2014 to March 2015,
encephalopathy was the most likely reason for readmission
(13 admissions), followed by bleeding (6), infection (6), and
shortness of breath (6). There was no improvement seen in the
hepatology readmission rate, with an overall rate of 36% in
Q4 of 2014. Conclusion: Preventing readmission in patients
with ESLD and high-risk decompensating events remains challenging,
especially in a high MELD at transplant region. Liver
transplantation is the only way to reduce readmissions in this
population, as the natural history of ESLD lends itself to frequent
hospitalization in the last stages of the disease. The target of a
hospital-based initiative to prevent readmission should perhaps
target those with a moderate risk for readmission in order to
have an impact.
Disclosures:
Jonathan M. Fenkel - Advisory Committees or Review Panels: Merck; Consulting:
Gilead Pharmaceuticals, Janssen Therapeutics, Bristol-Myers Squibb, Abbvie
Steven K. Herrine - Board Membership: ABIM; Grant/Research Support: BMS,
Gilead, Merck, Vertex
Jesse M. Civan - Consulting: Merck
The following authors have nothing to disclose: Sheela S. Reddy, Chad Gorn,
Stephania Dottin, Ann E. Burke, Karen Newell, Karen Pine, Ursula Hobbs, Maria
Neff, David A. Sass, She-Yan Wong, Dina Halegoua-De Marzio