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A chronic disease management model for chronic liver failure
Author(s) -
Wigg Alan J.,
Chinnaratha Mohamed A.,
Wundke Rachel,
Volk Michael L.
Publication year - 2015
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.27152
Subject(s) - medicine , hepatology , disease management , psychological intervention , health care , quality of life (healthcare) , intensive care medicine , chronic liver disease , cirrhosis , attendance , disease , randomized controlled trial , ambulatory care , liver disease , chronic care , chronic disease , nursing , parkinson's disease , economics , economic growth
Clinical Perspectives in Hepatology aims to engage experts with opinions supporting differing perspectives on the management of a case. Typically, the case represents an area of debate or evolving practice in clinical hepatology. The case described by Drs. Wigg, Chinnaratha, and Registered Nurse Wundke provides an opportunity to discuss the opportunities and challenges associated with chronic disease management models for patients with endstage liver disease. Chronic Disease Management (CDM) is a patientcentered approach to healthcare delivery that emphasizes proactive, longitudinal care between visits. Most healthcare systems are still based on acute illness disease models established at the beginning of the 20th century. In contrast, chronic illnesses now account for more than 75% of total healthcare expenditures. The episodic, symptomdriven nature of healthcare systems is poorly structured to manage this increasing burden of chronic conditions. Chronic liver failure (CLF) is one such condition, with a median time from diagnosis to death of 10 years, high morbidity, and frequent hospitalizations. In similar conditions such as heart failure, advances in CDM have substantially improved patient outcomes. These advances include relatively simple concepts such as patient education, medication reconciliation, and telephone management between visits. Recent pilot data suggest that similar interventions might also improve outcomes in cirrhosis. An Australian randomized controlled pilot trial (RCT) did not demonstrate significant differences in the hospital admission rates, severity of liver disease, or quality of life. However, benefits in outpatient clinic attendance and quality of care were observed. A second nonrandomized Italian study of 100 patients found reduced hospitalization, mortality, and costs in the intervention group. The following case report provides a demonstration of CDM principles and how they can be applied to a CLF patient. The response to the case and discussion offers an approach to advance the field of CDM models for CLF.