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Brahmania M, Rogal S, Serper M, Patel A, Goldberg D, Mathur A, Wilder J, Vittorio J, Yeoman A, Rich NE, Lazo M, Kardashian A, Asrani S, Spann A, Ufere N, Verma M, Verna E, Simpson D, Schold JD, Rosenblatt R, McElroy L, Wadwhani SI, Lee TH, Strauss AT, Chung RT, Aiza I, Carr R, Yang JM, Brady C, Fortune BE. Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease. Hepatol Commun 2024; 8:e0413. [PMID: 38696374 PMCID: PMC11068141 DOI: 10.1097/hc9.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/05/2024] [Indexed: 05/04/2024] Open
Abstract
Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.
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Affiliation(s)
- Mayur Brahmania
- Department of Medicine, Division of Gastroenterology and Transplant Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shari Rogal
- Department of Medicine, Division of Gastroenterology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arpan Patel
- Department of Medicine, Division of Gastroenterology, University of California Los Angeles, Los Angeles, California, USA
| | - David Goldberg
- Department of Medicine, Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Amit Mathur
- Department of Surgery, Division of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Julius Wilder
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Vittorio
- Department of Pediatrics, Division of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA
| | - Andrew Yeoman
- Department of Medicine, Gwent Liver Unit, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Nicole E. Rich
- Department of Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mariana Lazo
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ani Kardashian
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA
| | - Sumeet Asrani
- Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
| | - Ashley Spann
- Department of Medicine, Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nneka Ufere
- Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Dinee Simpson
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Jesse D. Schold
- Department of Surgery and Epidemiology, University of Colorado, Aurora, Colorado, USA
| | - Russell Rosenblatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Lisa McElroy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharad I. Wadwhani
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Tzu-Hao Lee
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Alexandra T. Strauss
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Raymond T. Chung
- Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ignacio Aiza
- Department of Medicine, Liver Unit, Hospital Ángeles Lomas, Mexico City, Mexico
| | - Rotonya Carr
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Jin Mo Yang
- Department of Medicine, Division of Gastroenterology, Catholic University of Korea, Seoul, Korea
| | - Carla Brady
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brett E. Fortune
- Department of Medicine, Division of Hepatology, Montefiore Einstein Medical Center, Bronx, New York, USA
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Kalo E, Baig A, Gregg E, George J, Read S, Ma WS, Ahlenstiel G. A novel, nurse-led 'one stop' clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival. BMC Gastroenterol 2023; 23:356. [PMID: 37845625 PMCID: PMC10578021 DOI: 10.1186/s12876-023-02986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Delivering effective secondary preventive and integrated care has the potential to break the revolving-door phenomenon of frequent readmissions in patients with advanced chronic liver disease. To address this, we launched the Care Coordination of Liver Disease (CCoLD) pilot, a novel nurse-led cirrhosis clinic in Western Sydney. METHODS AND ANALYSIS Following an index presentation to Blacktown or Mount Druitt hospitals (BMDH), patients (n = 89, matched by age, sex, and MELD-NA) were consecutively either followed up by the CCoLD clinical nurse consultant (intervention cohort) or received standard care (control cohort). Controlled evaluation of the impact of the nurse-led clinic was carried out for a 3-month period including readmission rates, survival, and cost effectiveness. RESULTS The inaugural nurse-led clinic led to improvement in patient-level outcomes including a reduction in unplanned liver-related readmissions (2.08% for intervention cohort vs 12.2% for control cohort, p < 0.01), and mortality at 30 days (0% for intervention cohort vs 7.3% for control cohort, p = 0.03). Similar trends were observed at 90 days from index discharge. No deaths were observed in the intervention cohort as compared to the control cohort at 90 days (0% versus 7.3%, p = 0.03), while unplanned liver-related readmissions were 10.41% for the intervention cohort vs 19.5% for the control cohort (p = 0.115). Moreover, time to readmission was significantly longer in the intervention cohort, resulting in an overall cost-effective intervention. CONCLUSION These findings highlight the significant impact of optimised care-coordination. A nurse-led clinic can deliver patient-centred, goal-directed, and cost-effective secondary prevention and care. A multicentre randomised trial for wider evaluation of these findings is warranted.
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Affiliation(s)
- Eric Kalo
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
| | - Asma Baig
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
| | - Emily Gregg
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia
- Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, 2145, Australia
| | - Scott Read
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia
| | - Wai-See Ma
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
| | - Golo Ahlenstiel
- Blacktown Clinical School and Research Centre, School of Medicine, Western Sydney University, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia.
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, 2145, Australia.
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Wish J, Villena-Vargas J, Harrison S, Lee B, Chow O, Port J, Altorki N, Stiles BM. Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code. World J Surg 2023; 47:2052-2064. [PMID: 37046063 DOI: 10.1007/s00268-023-07006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers. We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. METHODS Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18). Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). RESULTS We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). CONCLUSIONS Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes. Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code. Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.
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Affiliation(s)
- Jack Wish
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Villena-Vargas
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Ben Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, 111 East 210th Street, New York, NY, 10467, USA
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Zurek KI, Boswell CL, E. Miller N, L. Pecina J, D. Decker M, I. Wi C, Garrison GM. Association of Early and Late Hospital Readmissions with a Novel Housing-Based Socioeconomic Measure. Health Serv Res Manag Epidemiol 2022; 9:23333928221104644. [PMID: 35769114 PMCID: PMC9234927 DOI: 10.1177/23333928221104644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background While socioeconomic status has been linked to hospital readmissions for
several conditions, reliable measures of individual socioeconomic status are
often not available. HOUSES, a new measure of individual socioeconomic
status based upon objective public data about one's housing unit, is
inversely associated with overall hospitalization rate but it has not been
studied with respect to readmissions. Purpose To determine if patients in the lowest HOUSES quartile are more likely to be
readmitted within 30 days (short-term) and 180 days (long-term). Methods A retrospective cohort study of 11 993 patients having 21 633 admissions was
conducted using generalized linear mixed-effects models. Results HOUSES quartile did not show any significant association with early
readmission. However, when compared to the lowest HOUSES quartile, the
second quartile (OR = 0.90, 95%CI 0.83-0.98) and the third quartile
(OR = 0.91, 95%CI 0.83-0.99) were associated with lower odds of late
readmission while the highest quartile (OR = 0.91, 95%CI 0.82-1.01) was not
statistically different. Conclusion HOUSES was associated with late readmission, but not early readmission. This
may be because early readmissions are influenced by medical conditions and
hospital care while late readmissions are influenced by ambulatory care and
home-based factors. Since HOUSES relies on public county assessor data, it
is generally available and may be used to focus interventions on those at
highest risk for late readmission.
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Affiliation(s)
| | | | | | | | | | - Chung I. Wi
- Department of Pediatric and Adolescent Medicine, Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
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Ebhohon E, Ogundipe OA, Adejumo AC. Alarming rate of 30-day hospital readmissions in patients with liver cirrhosis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1608. [PMID: 34926652 PMCID: PMC8640909 DOI: 10.21037/atm-21-5258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Ebehiwele Ebhohon
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | - Adeyinka Charles Adejumo
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.,Individualized Genomics and Health Program, Johns Hopkins University, Baltimore, MD, USA
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