studies

216A AASLD ABSTRACTS HEPATOLOGY, October, 2015
17
A Prospective Study of a Protocol to Reduce Early Readmission
after Liver Transplantation
Mark W. Russo 1 , Amit Mori 1 , David Levi 2 , Ruth Pierce 2 , Siddesh
Besur 1 , Vincent P. Casingal 2 , Paul A. Schmeltzer 1 , Philippe J.
Zamor 1 , Andrew Delemos 1 , Lon Eskind 2 ; 1 Hepatology, Carolinas
Healthcare System, Charlotte, NC; 2 Transplant, Carolinas Medical
Center, Charlotte, NC
A Prospective Study of a Protocol to Reduce Early Readmission
after Liver Transplant Introduction: Hospital readmission
is an important marker of quality and delivery of care. Studies
have evaluated risk factors for readmission after liver transplant
(OLT) but few studies evaluated interventions to reduce
readmission. Aim: To reduce 30 day readmission rates after
OLT by implementing a prospective protocol with a multistep
strategy. Methods: In October 2013 a comprehensive strategy
was initiated to address early readmission after OLT. Core
components of the protocol included revising criteria for readmission,
alternatives to readmission, emphasized processes to
improve patient teaching and discharge planning and expansion
of outpatient services. 2014 served as the first full year
the protocol was implemented. Readmission rates for 2014
were compared to 2012 and 2013 with Fisher’s exact test and
ANOVA. Logistic regression was used to control for potential
confounding variables. Results: From January 1st 2012 thru
December 31st 2014 167 adult OLTs were performed at our
center with a mean biologic MELD of 21. The most common
indications were HCV (35%), NAFLD (18%), HCC (17%), and
ETOH (13%). The mean age of the study group was 54 y/o,
63% were male. The mean ICU LOS was 3.4 days and hospital
LOS 12.6 days. Over the study period 30 day readmission
rate was 34% and decreased after implementing the readmission
protocol from 40% in 2012 and 39% in 2013 to 19%
in 2014, p=0.04. The most common reasons for readmission
were biliary complications, infection, and rejection. Discharge
year (before or after implementing protocol) remained significant
after controlling for age, MELD score, indication, dialysis
pre and post liver transplant, distance from transplant center,
length of stay, PRBC transfusion, insurance and weekend discharge
OR=0.40 [95% CI 017,0.94], p=0.04. The top factors
identified as reducing readmission were expanding outpatient
services and alternatives to inpatient readmission. Conclusions:
Early readmission after liver transplantation can be reduced
by expanding outpatient services and implementing alternative
approaches to inpatient readmission.
Disclosures:
Mark W. Russo - Grant/Research Support: Merck, Salix; Speaking and Teaching:
janssen, Gilead, ABBVIE, Salix
Philippe J. Zamor - Grant/Research Support: AbbVie, Bristol Myers Squibb,
Gilead, Merck & Co. ; Speaking and Teaching: AbbVie, Bristol Myers Squibb,
Janssen
The following authors have nothing to disclose: Amit Mori, David Levi, Ruth
Pierce, Siddesh Besur, Vincent P. Casingal, Paul A. Schmeltzer, Andrew Delemos,
Lon Eskind
18
Reduced Work Productivity (WP), Absenteeism and
Presenteeism of Patients Infected with Hepatitis C Virus
(HCV) are Independently Predicted by Physical Component
of Patient-Reported Outcomes (PROs)
Zobair M. Younossi 1,2 , Maria Stepanova 3 , Linda Henry 3 , Issah
Younossi 3 , Ali A. Weinstein 3 , Fatema Nader 1 , Sharon L. Hunt 3 ;
1 Center For Liver Disease, Department of Medicine, Inova Fairfax
Hospital, Falls Church, VA; 2 Betty and Guy Beatty Center for Integrated
Research, Inova Health System, Falls Church, VA; 3 Center
for Outcomes Research in Liver Disease, Washington, DC
Background: Hepatitis C virus (HCV) infection is associated with
significant impairment of health-related quality of life (HRQOL)
and other PROs. Additionally, HCV infected patients are known
to have reduced work productivity (WP), both in terms of presenteeism
(impairment in work productivity while working) and
absenteeism (productivity loss due to absence from work). Aim:
The aim of this study was to identify PROs which are predictive
of WP in untreated HCV-infected patients. Methods: We
analyzed data from HCV patients prior to intitaion of anti-
HCV regimens in a clinical trial setting. All patients had completed
4 PRO questionnaires (CLDQ-HCV, SF-36, FACIT-F and
WPAI:SHP). In subjects who reported being employed, WP
and its absenteeism and presenteeism components were calculated
using WPAI:SHP instrument. Independent PRO predictors
of WP, absenteeism and presenteeism were assessed using
multiple linear regression. Results: Of 4,121 HCV patients who
completed pre-treatment WPAI:SHP, 2,480 (60.2%) reported
to be employed, and of those, 2,121 had completed all PRO
questionnaires before treatment initiation. The study cohort was
51.1±9.6 years old, 16.7% cirrhotic, 76.1% HCV genotype 1,
and 62.3% treatment-naïve. Average baseline impairment in
WP was 11.0%, including 8.3% (75% of WP impairment) of
presenteeism and 2.7% (25% of WP impairment) of absenteeism.
Using multivariate regression analysis, WP was predicted
by the activity/energy domain of CLDQ-HCV (beta=4.55±0.56
per 1 point, p