A novel, nurse-led ‘one stop’ clinic for patients with liver cirrhosis results in fewer liver-related unplanned readmissions and improved survival

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

【研究目的】实施有效的二级预防与整合照护，有望打破晚期慢性肝病患者反复入院的“回旋门”循环现象。为此，我们启动了肝病护理协调（Care Coordination of Liver Disease, CCoLD）试点项目——西悉尼首个由护士主导的肝硬化门诊。
【研究方法与方案】在布莱克敦医院与德鲁伊特山医院（Blacktown or Mount Druitt Hospitals, BMDH）完成首次就诊后，按年龄、性别及终末期肝病模型-钠评分（MELD-Na）匹配的89例患者被连续纳入研究，分别接受CCoLD临床护理顾问的随访干预（干预组）或标准诊疗照护（对照组）。本研究对该护士主导门诊的干预效果开展了为期3个月的对照评估，评估指标包括再入院率、生存率及成本效益。
【研究结果】首个护士主导门诊的实施改善了患者层面的结局指标，其中非计划性肝病相关再入院率显著降低（干预组2.08% vs 对照组12.2%，p