The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: Early outcomes from a multidisciplinary clinic
Recommended Citation
Sengupta S, Anand A, Yang Q, Reagan M, Husted M, Minnick A, Nagy LE, Dasarathy S, Sims OT, and Mellinger JL. The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: Early outcomes from a multidisciplinary clinic. Hepatol Commun 2025; 9(2).
Document Type
Article
Publication Date
2-1-2025
Publication Title
Hepatol Commun
Abstract
BACKGROUND: We analyzed early outcomes regarding the impact of our integrated alcohol-associated liver disease (ALD) clinic on patients with ALD and alcohol use.
METHODS: We conducted a retrospective study of patients with ALD who were evaluated in our integrated clinic from May 1, 2022, to December 31, 2023. Primary outcomes included differences in baseline clinical/demographic data between patients who accepted versus declined an appointment and changes in the severity of ALD, alcohol consumption, functional status, hospital utilization, and remission in alcohol use disorder for evaluated patients.
RESULTS: Patients who declined appointments (n=66) had higher median no-show rates (15.0 [8.0,30.0] vs. 8.5 [3.25,15.0], p< 0.001), social vulnerability index (0.53 [0.26,0.79] vs. 0.38 [0.17,0.63], p=0.033), and proportions of cirrhosis (78.8% vs. 59.8%, p=0.017) versus evaluated patients. Comparison of baseline to first follow-up visit for evaluated patients (n=102) demonstrated significant reductions in median AST (59.5 [41.75, 89] vs. 44.5 [33.5, 56.25], p< 0.001), alanine-aminotransferase (33.5 [20,45.25] vs. 26.5 [18.75,33.0], p=0.017), total bilirubin (1.6 [0.7,3.3] vs. 1 [0.5,1.9], p=0.001), phosphatidylethanol (263 [35, 784] vs. 0 [0, 163], p< 0.001), MELD-3.0 and Sodium scores for patients with alcohol-associated hepatitis and cirrhosis (16 [11, 18.75] vs. 12 [9, 14], p< 0.001), 14 [9.25, 17.75] vs. 11 [8.5, 14], p< 0.001), and Child-Turcotte-Pugh scores for patients with cirrhosis (9 [6, 10.5] vs. 7 [6, 9], p< 0.001). The proportion of patients with active-severe alcohol use disorder significantly decreased (85.2% vs. 51.9%, p< 0.001). Additionally, patients had significant reductions in emergency department utilization (incidence rate ratio of 0.64 emergency department visits/month (p=0.002) and 0.71 hospital admissions/month (p=0.025). However, after considering the false discovery rate, the reduction in hospitalization admissions/month was not statistically significant (False Discovery Rate adjusted p=0.056).
CONCLUSIONS: Our integrated approach led to reductions in liver injury, degree of liver decompensation, alcohol use, and ED utilization, and remission in AUD in a population of both non-transplant ALD and post-transplant patients.
Medical Subject Headings
Humans; Male; Female; Retrospective Studies; Middle Aged; Liver Diseases, Alcoholic; Delivery of Health Care, Integrated; Adult; Severity of Illness Index; Alcohol Drinking; Aged; Hospitalization
PubMed ID
39927894
Volume
9
Issue
2