Evidence map›Paper›PMID 38652390›Full record

ArticleDigestive diseases and sciences2024

A Prospective Multimodal Education Intervention for Providers Does Not Increase Hepatic Encephalopathy Treatment Rates.

Patrick A Twohig, Thoetchai Bee Peeraphatdit, Kaeli Samson, Makayla Schissel, Lynette Smith, Allison Ashford, Laura Freese, Timothy McCashland

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Article in Digestive diseases and sciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed, 0 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Patrick A TwohigDivision of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198-2000, USA. patwohig@gmail.com.ORCID http://orcid.org/0000-0002-5423-8749
Thoetchai Bee PeeraphatditDivision of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198-2000, USA.
Kaeli SamsonDepartment of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA.
Makayla SchisselDepartment of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA.
Lynette SmithDepartment of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA.
Allison AshfordDepartments of Internal Medicine & Hospital Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
Laura FreeseDepartments of Internal Medicine & Hospital Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
Timothy McCashlandDepartment of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA.
University of Nebraska Medical Center · USNebraska Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOver 50% of hospitalizations from hepatic encephalopathy (HE) are preventable, but patients often do not receive medical treatment.

aimsTo use a multimodal education intervention (MMEI) to increase HE treatment rates and to evaluate (1) trends in HE treatment, (2) predictors of receiving treatment, and (3) the impact of treatment on hospitalization outcomes.

methodsProspective single-center cohort study of patients hospitalized with HE from April 1, 2020-September 30, 2022. The first 15 months were a control ("pre-MMEI"), the subsequent 15 months (MMEI) included three phases: (1) prior authorization resources, (2) electronic order set, and (3) in-person provider education. Treatment included receiving any drug (lactulose or rifaximin), or combination therapy. Treatment rates pre- vs. post-MMEI were compared using logistic regression.

results471 patients were included. There were lower odds of receiving any drug post-MMEI (p = 0.03). There was no difference in receiving combination therapy pre- or post-MMEI (p = 0.32). Predictors of receiving any drug included alcohol-related or cryptogenic cirrhosis (p's < 0.001), and the presence of ascites (p = 0.005) and/or portal hypertension (p = 0.003). The only significant predictor of not receiving any drug treatment was having autoimmune cirrhosis (p < 0.001). Patients seen by internal medicine (p = 0.01) or who were intoxicated (p = 0.02) were less likely to receive rifaximin. Any treatment was associated with higher 30-day liver disease-specific readmission (p < 0.001).

conclusionThis MMEI did not increase HE treatment rates, suggesting that alternative strategies are needed to identify and address barriers to treatment.

Indexed as

Hepatic EncephalopathyRifaximinAgedDrug Therapy, CombinationFemaleGastrointestinal AgentsHospitalizationHumansLactuloseMaleMiddle AgedProspective StudiesGastrointestinal AgentsLactuloseRifaximinHepatic encephalopathyHospitalizationHospital readmissionInpatient mortalityMedical educationQuality improvement

Identifiers

PMID38652390
OpenAlexW4395049005

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.