Care Coordination for Patients Admitted With Alcohol-Associated Liver Disease: An Assessment of Appropriate Follow-up and Treatment at Time of Discharge.
BACKGROUND AND AIMS: The prevalence of alcohol-associated liver disease (ALD) is on the rise in the United States, and effective management requires multidisciplinary care and coordination of services across specialties. The aim of this study is to assess whether patients hospitalized with alcohol use disorder (AUD) and ALD have access to appropriate provider follow-up and treatment at time of discharge as well as to identify factors that enable care coordination. METHODS: Hospital admissions for adults with ALD and AUD between January 1, 2022, and December 31, 2022, at our institution were identified. Medical records were reviewed to identify clinical characteristics as well as attendance at a hepatology appointment within 90 days of discharge (primary endpoint), referral to substance use services at discharge, and prescription of medication for AUD at discharge (secondary endpoints). Logistic regression modeling with repeated admissions within patient was performed to identify independent associations with each outcome. RESULTS: Among the hospital admissions, 417 met the inclusion criteria. Following 16% of admissions, patients attended a hepatology appointment, 4% of patients were referred to substance use services, and 14% of patients were prescribed medication for AUD. Among modifiable factors, hepatology and social work evaluation during hospitalization were associated with successful care coordination. CONCLUSION: In our population, rates of specialist follow-up and treatment for AUD and ALD after a hospital admission were overall low. This study not only highlights a significant gap in care delivery for patients with ALD, but it also identifies a critical need to establish quality measures for the inpatient management and long-term follow-up for patients ALD.
