Clinical and translational gastroenterology · 2026
The Cirrhosis Medical Home: A Pilot Randomized Trial of a Collaborative Care Model for Patients With Decompensated Cirrhosis.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Orman Eric S, Desai Archita P, Kuchana Sai K, Campbell Noll, Fowler Nicole R, McCarty Jake, Pike Francis, Mosesso Kelly, Hotchkiss Timothy, Chalasani Naga P, Boustani Malaz
Аннотация
INTRODUCTION: Patients with decompensated cirrhosis have a high symptom burden and poor outcomes. Collaborative care models that provide coordinated, personalized care could improve outcomes. In this pilot randomized trial, we tested a cirrhosis-centric collaborative care model: the Cirrhosis Medical Home (CMH).
METHODS: A single-center pilot randomized trial enrolling 40 hospitalized adults with decompensated cirrhosis randomized 1:1 to CMH or usual care. CMH involved 6 months of postdischarge individualized care. Primary outcomes were feasibility-based (enrollment, retention, data completeness). Secondary outcomes at 3 and 6 months included quality of life (SF-36) and healthcare utilization.
RESULTS: Of 205 patients screened, 40 were enrolled. Of the 20 patients randomized to CMH, 13 received postdischarge CMH follow-up. At 3 months, 19 died or had a transplant, 9 were lost to follow-up, and 12 completed the SF-36. At 6 months, an additional 4 died or were lost to follow-up, and 8 completed the SF-36. In intention-to-treat analysis at 3 months, CMH did not improve quality of life. In per protocol analysis at 3 months, CMH improved physical functioning (delta +15 vs -10, P = 0.015), energy/fatigue (+20 vs -5, P = 0.02), and physical component score (+5.5 vs -5.0, P = 0.009). High mortality and readmission rates were seen in both arms but without significant differences.
DISCUSSION: Enrollment and retention in a randomized trial of the CMH for posthospitalization management of decompensated cirrhosis is challenging, and patient-reported outcome assessment is limited by high rates of mortality, transplant, and loss to follow-up. These data can be used to inform future design and testing of health services interventions for this population.
METHODS: A single-center pilot randomized trial enrolling 40 hospitalized adults with decompensated cirrhosis randomized 1:1 to CMH or usual care. CMH involved 6 months of postdischarge individualized care. Primary outcomes were feasibility-based (enrollment, retention, data completeness). Secondary outcomes at 3 and 6 months included quality of life (SF-36) and healthcare utilization.
RESULTS: Of 205 patients screened, 40 were enrolled. Of the 20 patients randomized to CMH, 13 received postdischarge CMH follow-up. At 3 months, 19 died or had a transplant, 9 were lost to follow-up, and 12 completed the SF-36. At 6 months, an additional 4 died or were lost to follow-up, and 8 completed the SF-36. In intention-to-treat analysis at 3 months, CMH did not improve quality of life. In per protocol analysis at 3 months, CMH improved physical functioning (delta +15 vs -10, P = 0.015), energy/fatigue (+20 vs -5, P = 0.02), and physical component score (+5.5 vs -5.0, P = 0.009). High mortality and readmission rates were seen in both arms but without significant differences.
DISCUSSION: Enrollment and retention in a randomized trial of the CMH for posthospitalization management of decompensated cirrhosis is challenging, and patient-reported outcome assessment is limited by high rates of mortality, transplant, and loss to follow-up. These data can be used to inform future design and testing of health services interventions for this population.