A Nonrandomized Pilot Study to Investigate the Acceptability and Feasibility of LivR Well: A Multifaceted 28-Day Home-Based Liver Optimization Program for Acute-on-Chronic Liver Failure
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Background and Aims Acute-on-chronic liver failure (ACLF) has a 22%–74% 28-day mortality rate and 30%–40% 30-day readmission rate. We investigated the acceptability and feasibility of a multimodal community intervention for ACLF. Methods A single-arm nonrandomized pilot study of consecutive participants with ACLF was conducted in a tertiary health service. Participants received weekly medical and nursing reviews, dietetics, physiotherapy, pharmacy, social work, addiction medicine, and neuropsychiatry, where indicated. A digital platform included remote weight monitoring and online surveys. The primary outcome was acceptability/feasibility. Secondary outcomes included safety, mortality, readmission, liver disease severity, and costs. Results Fifty-nine patients were enrolled with median age 51 years (interquartile range (IQR): 45–59); majority alcohol etiology (74%),and median Model for End-Stage Liver Disease Sodium score 16 (IQR: 12–21). LivR Well was acceptable with low attrition (8 of 59), adherence to the program including home visits (mean 8.4 ± 4.2) and consultations (mean 2.4 ± 1.5) per patient. This was supported by positive feedback and themes identified through a qualitative subanalysis. Feasibility was demonstrated by recruitment rate of 4.94 patients/month and 86% completion. Mortality was lower than expected at 3%, 30-day readmission rate was 15%, and median Model for End-Stage Liver Disease Sodium score reduced to 15 ( P = .01). Median 6-month costs reduced from $30,454 (IQR: $21,953–$65,657) to $17,657 ($4249–$42,876) ( P = .009). The total 6-month health-care cost was $1,868,859 (95% confidence interval 1,081,821–2,655,897) compared to $2,518,227 (95% confidence interval 1,959,610–3,076,844). Conclusion LivR Well was acceptable, feasible, and safe with low short-term mortality and readmission rates. Health-care costs were reduced by 26% driven by a 40% reduction in 30-day readmission. Further evaluation includes a randomized controlled trial of LivR Well compared to standard care.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- A Nonrandomized Pilot Study to Investigate the Acceptability and Feasibility of LivR Well: A Multifaceted 28-Day Home-Based Liver Optimization Program for Acute-on-Chronic Liver Failure
- Date Crossref
- 01/01/2025
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Monash Health pays non établi dans la noticeÉtablissement de santé
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Monash University Monash Digital Therapeutics and Innovation Laboratory (MoTILa) pays non établi dans la noticeUniversité ou école supérieure
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The University of Melbourne pays non établi dans la noticeUniversité ou école supérieure
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The University of Adelaide Adelaide Medical School pays non établi dans la noticeUniversité ou école supérieure
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Department of Gastroenterology and Hepatology pays non établi dans la noticeInstitution
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Faculty of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Pharmacy Department pays non établi dans la noticeInstitution
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Hospital in the Home pays non établi dans la noticeÉtablissement de santé
Monash Health, Monash Digital Therapeutics and Innovation Laboratory (MoTILa) — Monash University et The University of Melbourne, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.