Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital.
J Gen Intern Med
; 39(7): 1245-1251, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38378980
ABSTRACT
BACKGROUND:
Disparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care.AIM:
To implement a novel generalist-led FLuid ASPiration (FLASP) clinic to reduce emergency department (ED) care for refractory ascites.SETTING:
A large safety net hospital in Los Angeles.PARTICIPANTS:
MediCal patients with paracentesis in the ED from 6/1/2020 to 1/31/2021 or in FLASP clinic or the ED from 3/1/2021 to 4/30/2022. PROGRAM DESCRIPTION According to RE-AIM, adoption obtained administrative endorsement and oriented ED staff. Reach engaged ED staff and eligible patients with timely access to FLASP. Implementation trained FLASP clinicians in safer, guideline-based paracentesis, facilitated timely access, and offered patient education and support. PROGRAM EVALUATION After FLASP clinic opened, significantly fewer ED visits were made by patients discharged after paracentesis [rate ratio (RR) of 0.33 (95% CI 0.28, 0.40, p < 0.0001)] but not if subsequently hospitalized (RR = 0.88, 95% CI 0.70, 1.11). Among 2685 paracenteses in 225 FLASP patients, complications were infrequent 39 (1.5%) spontaneous bacterial peritonitis, 265 (9.9%) acute kidney injury, and 2 (< 0.001%) hypotension. FLASP patients rated satisfaction highly on a Likert-type question.DISCUSSION:
Patients with refractory ascites in large safety net hospitals may benefit from an outpatient procedure clinic instead of ED care.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Poverty
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Ascites
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Healthcare Disparities
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Safety-net Providers
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Ambulatory Care Facilities
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Liver Cirrhosis
Limits:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
J Gen Intern Med
Journal subject:
MEDICINA INTERNA
Year:
2024
Type:
Article
Affiliation country:
United States