Project Description
Improving the Delivery of Palliative Care to Hospitalized Adults with Acute on Chronic Liver Failure
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.
Bio
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.
Email: ArpanPatel@mednet.ucla.edu