The Patient Buddy App Can Potentially Prevent Hepatic Encephalopathy-related Readmissions

Dinesh Ganapathy; Chathur Acharya; Jatinder Lachar; Kavish Patidar; Richard K. Sterling; Melanie B. White; Catherine Ignudo; Swamy Bommidi; John DeSoto; Leroy R. Thacker; Scott Matherly; Jawaid Shaw; Mohammad S. Siddiqui; Puneet Puri; Arun J. Sanyal; Velimir Luketic; Hannah Lee; Richard T. Stravitz; Jasmohan S. Bajaj

Disclosures

Liver International. 2017;37(12):1843-1851. 

In This Article

Abstract and Introduction

Abstract

Background & Aims. Readmissions are a major burden in cirrhosis. A proportion of readmissions in cirrhosis, especially because of hepatic encephalopathy (HE) could be avoided through patient and caregiver engagement. We aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study.

Methods. Cirrhotic inpatients with caregivers were enrolled and followed for 30 days post-discharge. On separately assigned devices loaded with Patient Buddy, they were trained on entering medication adherence, daily sodium intake and weights, and weekly cognitive (EncephalApp_Stroop) and fall-risk assessment and were educated regarding cirrhosis-related symptoms. These were monitored daily through a Patient Buddy loaded iPad by the clinical team. The App sent automatic alerts between patient/caregivers and clinical team regarding adherence and critical values. At 30 days, total, and HE-related admissions were analysed as well as the feasibility and feedback regarding educational values.

Results. Forty patients and 40 caregivers were enrolled. Seventeen patients were readmitted within 30-days but none for HE. Eight potential HE-related readmissions were prevented through App-generated alerts that encouraged early outpatient interventions. Caregivers and patients were concordant in data entry but six did not complete data entries. Most respondents rated the App favourably for its educational value.

Conclusions. In this proof-of-concept trial, the use of Patient Buddy is feasible in recently discharged patients with cirrhosis and their caregivers. Eight HE-related readmissions were potentially avoided after the use of the App.

Introduction

Patients with cirrhosis have a high rate of readmissions, which are associated with adverse outcomes related to medical, psycho-social and healthcare expenditure. A major cause of readmissions is hepatic encephalopathy (HE), which is a major healthcare expenditure target.[1–3] Current clinical practice has focused on written and verbal communications to the patients with an as-needed involvement of caregivers at discharge. In addition, there is a variable policy about return appointments that adds another element of uncertainty.[4] It is therefore likely that a proportion of readmissions within 30 days, especially related to HE, are potentially avoidable. Prior studies have shown that interactions between the clinical teams, patients and caregivers can change this readmission risk variably.[5–8] We hypothesized that encouraging communication between patients, caregivers and the clinical team and increasing education through an innovative App (Patient Buddy) which encourages early intervention would be feasible in patients and caregivers with cirrhosis in a proof-of-concept study.

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