Patients at the University of Pennsylvania Health System with cirrhosis, or end stage liver disease, are at a high risk of early readmission from the hospital, with 30 day re-admission rates of up to 20-35%. This project is designed to study whether TeleHealth interventions after hospital discharge have the potential to improve patient outcomes and prevent early readmissions in patients with cirrhosis who have risk factors for early readmission. After discharge from the hospital, patients receive tablets that monitor blood pressure, weight, medication compliance, and symptoms. Signs of clinical deterioration trigger a phone call to a nurse coordinator who triages the issue and determines if any intervention is indicated for that patient. The project is currently in its pilot phase, with a planned randomized control trial with some patients getting the tablet for 90 days and others getting standard home nursing care.
The pilot phase of this study has enrolled 11 patients with ongoing enrollment. To date, only 1 of the patients has been readmitted to the hospital. Though the numbers are too small to draw any conclusions, they are promising. To increase enrollment, we have started screening patients at 2 additional hospitals within the University of Pennsylvania health system.