Health IT-Generated PROs to Improve Outcomes in Cirrhosis

Cirrhosis affects more than 6 million people in the United States and places significant clinical, emotional, and financial demands on patients, caregivers, and healthcare systems. Individuals with advanced cirrhosis are prone to complications that often lead to hospital readmissions, worsening outcomes, and increasing costs. PROs, such as changes in sleep, cognition, pain, and daily function, can signal early deterioration but are difficult to manage at scale using traditional models like specialized clinics or in-person monitoring.

To help reduce avoidable hospital readmissions, which remain high despite targeted efforts, researchers at Virginia Commonwealth University Medical Center, in collaboration with Creative Information Technology Inc., developed and tested Patient Buddy and EncephalApp. Patient Buddy is a mobile app for patients and caregivers that tracks daily health metrics, supports secure communication, and alerts providers to potential concerns. EncephalApp is a smartphone-based tool for screening and guiding therapy for cognitive dysfunction associated with late-stage cirrhosis. Together, they integrate electronic health record data and cognitive screening results to flag compliance issues, prompt patients to complete assessments, and notify care teams of abnormalities. Building on prior research showing feasibility and acceptance, researchers evaluated the integrated tools for their ability to improve monitoring, adherence, and early intervention during the critical 30-day post-discharge period, as well as their scalability across diverse clinical settings.

The specific aims of the research were as follows:

• Evaluate in a multi-center, randomized trial the effectiveness of PROs elicited using Patient Buddy and EncephalApp with and without scheduled outpatient return visits on preventing avoidable 30-day readmissions in patients with cirrhosis and their caregivers compared to standard of care.
• Incorporate the opinion of key stakeholders (patients, caregivers, and nurse managers) toward improving the Patient Buddy App in preventing readmission in cirrhosis.

In the trial, 464 hospitalized adults with cirrhosis and their caregivers were recruited from a private hospital, a U.S. Department of Veterans Affairs hospital, and a safety-net hospital, then randomized to standard of care or the intervention group. Intervention participants tracked metrics such as medication use, bowel movements, weight, abdominal girth, temperature, and cognitive function using the integrated tools, and clinical teams monitored alerts for timely follow-up. All participants were followed for 30 days post-discharge, and an independent, blinded board reviewed each readmission to determine avoidability. Researchers also collected feedback from stakeholders on usability, user effort, and effectiveness.

Early findings underscore both the promise and challenges of using digital health tools in this population. In two peer-reviewed publications, the researchers reported that patients with advanced cirrhosis were more likely to participate in the intervention, while caregiver concerns about effort and technology demands were the main reasons for declining. Providers generally felt confident using the tools, but the volume of app alerts created significant monitoring demands. These findings highlight the importance of addressing caregiver and provider challenges to ensure long-term success. The team is refining the tools based on feedback to support broader adoption.