Quantifying days at home in patients with cirrhosis: A national cohort study.
Hepatology
; 78(2): 518-529, 2023 08 01.
Article
em En
| MEDLINE
| ID: mdl-36994701
ABSTRACT
BACKGROUND AND AIMS:
Days at home (DAH) is a patient-centric metric developed by the Medicare Payment Advisory Commission, capturing annual health care use, including and beyond hospitalizations and mortality. We quantified DAH and assessed factors associated with DAH differences among patients with cirrhosis. APPROACH ANDRESULTS:
Using a national claims database (Optum) between 2014 and 2018, we calculated DAH (365 minus mortality, inpatient, observation, postacute, and emergency department days). Among 20,776,597 patients, 63,477 had cirrhosis (median age, 66, 52% males, and 63% non-Hispanic White). Age-adjusted mean DAH for cirrhosis was 335.1 days (95% CI 335.0 to 335.2) vs 360.1 (95% CI 360.1 to 360.1) without cirrhosis. In mixed-effects linear regression, adjusted for demographic and clinical characteristics, patients with decompensated cirrhosis spent 15.2 days (95% CI 14.4 to 15.8) in postacute, emergency, and observation settings and 13.8 days (95% CI 13.5 to 14.0) hospitalized. Hepatic encephalopathy (-29.2 d, 95% CI -30.4 to -28.0), ascites (-34.6 d, 95% CI -35.3 to -33.9), and combined ascites and hepatic encephalopathy (-63.8 d, 95% CI -65.0 to -62.6) were associated with decreased DAH. Variceal bleeding was not associated with a change in DAH (-0.2 d, 95% CI -1.6 to +1.1). Among hospitalized patients, during the 365 days after index hospitalization, patients with cirrhosis had fewer age-adjusted DAH (272.8 d, 95% CI 271.5 to 274.1) than congestive heart failure (288.0 d, 95% CI 287.7 to 288.3) and chronic obstructive pulmonary disease (296.6 d, 95% CI 296.3 to 297.0).CONCLUSIONS:
In this national study, we found that patients with cirrhosis spend as many, if not more, cumulative days receiving postacute, emergency, and observational care, as hospitalized care. Ultimately, up to 2 months of DAH are lost annually with the onset of liver decompensation. DAH may be a useful metric for patients and health systems alike.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Encefalopatia Hepática
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Hepatology
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos