title: An Automated Telephone Monitoring System to Identify Patients with Cirrhosis at Risk of Re-hospitalization.
abstract: OBJECTIVE
  Hospitalizations for cirrhosis are costly and associated with increased mortality. Disease management outside of clinic, such as the use of interactive voice response (IVR) calls, may identify signs to prevent hospitalization. The aim of this study was to investigate whether IVR monitoring can predict hospitalization and mortality in cirrhosis.
  
  
  METHODS
  One hundred patients with decompensated cirrhosis were enrolled in this observational study, of which 79 patients were included in the final analysis. Participants were followed until death, transplant, or last clinical follow-up (range 7-874 days). Analysis focused on potential predictors identified during the first month of IVR calls: presence of jaundice, abdominal/leg swelling, weakness, paracentesis requirement, medication changes, and weight change. The primary outcome was time to first hospital admission; secondary outcomes included hospitalization and time to death. Potential predictors with a p value <0.1 were further analyzed after adjustment for covariates (Model for End-stage Liver Disease score, serum sodium, number of medications).
  
  
  RESULTS
  Twenty (25%) patients died, and 49 (62%) were hospitalized at least once. Fifty-six (70%) patients completed >80% of their IVR calls. After adjustment for covariates, weakness was associated with an increased risk of first hospitalization (HR 2.14, CI 1.13-4.05, p = 0.02) and hospitalization rate (HR 2.1, CI 1.0-4.3, p = 0.048). Weight change of ≥ five pounds (2.3 kg) in a week increased the rate of hospitalization by 2.7 (CI 1.0-7.1, p = 0.045). No variable predicted death after covariate adjustment.
  
  
  CONCLUSIONS
  These results suggest IVR calls can be used to predict hospitalization in cirrhosis.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 2F208 UH, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. maryjt@med.umich.edu.
authors.forename: Mary
authors.identifier: http://orcid.org/0000-0003-1505-9091
authors.initials: M
authors.lastname: Thomson
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, MI, USA. mvolk@llu.edu.|Loma Linda University Medical Center Transplantation Institute, 25865 Barton Rd, Suite 101, Loma Linda, CA, 92354, USA. mvolk@llu.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Volk
authors.affiliation: Center for Statistical Consultation and Research, University of Michigan, 3550 Rackham, 915 E. Washington St., Ann Arbor, MI, 48109, USA. myrakim@umich.edu.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, 2F208 UH, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. jpiette@med.umich.edu.|Health Services Research and Development Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA. jpiette@med.umich.edu.|Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 49109, USA. jpiette@med.umich.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012307:Risk Factors; D013689:Telephone; D055815:Young Adult
keywords: Cirrhosis; Hospitalization; Patient care management; Telemedicine