title: How to improve care in outpatients with cirrhosis and ascites: a new model of care coordination by consultant hepatologists.
abstract: OBJECTIVE
  The development of ascites in patients with cirrhosis is associated with a high rate of health care utilization. New models of specialized caregiving support are necessary to optimize its management. The aim of the study was to evaluate the efficacy and financial sustainability of the "Care management check-up" as a new model of specialized caregiving support based on a series of diagnostic facilities performed in real time and on the integrated activity of consultant hepatologists at the hospital unit for outpatients, dedicated nurses, physicians in training and primary physicians, compared to standard care in outpatients with cirrhosis and ascites.
  
  
  METHODS
  100 cirrhotic patients admitted to our hospital were allocated, after discharge, to the "Care management check-up" group (group 1), or to the "Standard outpatient care" group (group 2), and followed prospectively as outpatients up to death or for at least 12 months. Patients of the two groups could also access to a "Day hospital" when an invasive procedure was required. In group 1, the "Care management check-up" and the "Day hospital" taken together defined the "Care management program".
  
  
  RESULTS
  Twelve-month mortality was higher in group 2 than in group 1 (45.7% vs. 23.1%, p<0.025). The rate of 30-day readmission was also higher in group 2 (42.4% vs. 15.4%, p<0.01). The global cost attributable to the management per patient-month of life was lower (1479.19 ± 2184.43 €) in group 1 than (2816.13 ± 3893.03 €) in group 2 (p<0.05).
  
  
  CONCLUSIONS
  The study suggests that this new model of specialized caregiving reduces 12-month mortality in patients with cirrhosis and ascites as well as the global health care costs for their management.
authors.affiliation: Department of Medicine, DIMED, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.forename: Giulio
authors.initials: G
authors.lastname: Maresio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.forename: Antonietta
authors.initials: A
authors.lastname: Romano
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Stanco
authors.forename: Carla
authors.initials: C
authors.lastname: Destro
authors.forename: Giampietro
authors.initials: G
authors.lastname: Rupolo
authors.forename: Domenico
authors.initials: D
authors.lastname: Mantoan
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D001201:Ascites / Q000628:therapy; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D017048:Health Care Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010359:Patient Readmission; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012044:Regression Analysis
keywords: CTP; Care management program; Child-Turcotte-Pugh; Day hospital; HCC; HE; Health care costs; Health care system; Hospital readmission; LT; MELD; Model for End Stage Liver Disease; Mortality; Quality of assistance; SOFA; euro; hepatic encephalopathy; hepatocellular carcinoma; liver transplantation; sequential organ failure assessment; €