Patient Buddy App for the Prevention of Avoidable Readmission in Cirrhosis

Specific aim 1: To perform a pilot and feasibility study of disseminating current knowledge of readmission prevention in cirrhosis by using the Patient Buddy App with patient and caregiver interfaces. Eighty subjects (40 cirrhotic inpatients and 40 caregivers) will be enrolled and trained on the Patient Buddy at discharge. The App focuses on daily communication between patient/caregivers and the study team based on previously identified risk factors associated with readmission. The study team will initiate measures to prevent readmission using these communications. A detailed analysis of 30-day readmissions and input of the patients,caregivers and nurse manager will be performed to improve the App. Avoidable readmissions will be defined by a committee of hepatologists who is not part of the study at VCU.

Specific aim 2: To incorporate the opinion of key stakeholders (patients, caregivers and case managers) towards improving the Patient Buddy App in the prevention of avoidable readmission in cirrhosis. The input of the key stakeholders and the analysis of readmissions prevented during the pilot study will be used to update the App for preventing avoidable readmissions in future studies

Inclusion criteria

• Cirrhosis patients ≥21 years of age hospitalized for non-elective reasons
• Adult caregiver and the patient living in the same house
• Both (caregiver and patient) should be able to complete the Patient Buddy training and evaluation
• Discharged home from the hospital
• Patients who have VCU as a primary hospital base

Exclusion criteria

• Elective hospitalization
• Lack of an adult caregiver
• Active alcohol/substance abuse within 1 month of the hospitalization
• Unable to perform training or give consent
• Patients discharged to hospice, nursing home or extended care facilities
• Patients on Hemodialysis