The National Palliative Care Research Center

Curing suffering through palliative care research.


Arpan Patel MD, PhD

Assistant Professor

University of California, Los Angeles

Grant Year
Grant Term
2 years
Grant Type
Kornfeld Scholars Program

Project Description
Improving the Delivery of Palliative Care to Hospitalized Adults with Acute on Chronic Liver FailureĀ 

Acute on chronic liver failure (ACLF) is a highly morbid condition that commonly affects hospitalized adults with decompensated cirrhosis, with a 90-day mortality of over 50%. Since patients often experience rapid declines during hospitalizations, timely identification of ACLF, incorporation of palliative care principles, and consideration of liver transplantation are needed to ensure high quality care for this population, but these are rarely provided. Integrated care is an approach to care delivery that aims to improve patient care and experience through improved coordination and communication, which may help close these gaps. How to best deploy integrated care for patients with serious liver-related illnesses, such as cirrhosis and ACLF, however, is unknown.     The goal of this proposal is to pilot an integrated care intervention that incorporates specialist prognostication, patient priorities, and interdisciplinary support to execute patient-centered care plans for hospitalized patients with ACLF. Specifically, I aim to: 1) to refine I-3LD (Integrated, Interdisciplinary, and Individualized Care for Liver Disease), a scalable, integrated care intervention for hospitalized Veterans with ACLF and 2) to demonstrate feasibility, acceptability, fidelity, and preliminary effects of I-3LD for 60 hospitalized adults (30 control, 30 intervention) with ACLF using a pre-test, post-test design. This award provides me needed time to improve my skillsets in pragmatic and implementation trial design, outcome measurement, and palliative care. It will also pave the way for me to become an independent investigator capable of integrating palliative care throughout the trajectory of illness for patients with cirrhosis. 
Arpan Patel, MD, PhD, is Assistant Professor of Medicine at the David Geffen School of Medicine at UCLA and a staff hepatologist at the VA Greater Los Angeles Healthcare System, where he is also Core Investigator at the Center for Study of Healthcare Innovation, Implementation and Policy (CSHIIP).  Dr. Patel’s research aims to integrate principles of palliative care in the management of patients with serious illnesses affecting the liver.  He has specific interest in improving serious illness communication between patients and providers.