PATHWAYS OF CARE AND ACCESS TO RIFAXIMIN POST-DISCHARGE IN MEDICARE-INSURED PATIENTS WITH OVERT HEPATIC ENCEPHALOPATHY
Author(s)
Arun B Jesudian, MD1, Patrick Gagnon-Sanschagrin, MSc2, Rebecca Bungay, MScPH3, Kaitlyn Easson, PhD2, Kana Yokoji, MScPH2, Annie Guerin, MSc2, Olamide Olujohungbe, PharmD4, Leonardo Passos Chaves, MD4;
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Montreal, QC, Canada, 3Analysis Group, Toronto, ON, Canada, 4Bausch Health, Bridgewater, NJ, USA
1Weill Cornell Medicine, New York, NY, USA, 2Analysis Group, Montreal, QC, Canada, 3Analysis Group, Toronto, ON, Canada, 4Bausch Health, Bridgewater, NJ, USA
OBJECTIVES: Overt hepatic encephalopathy (OHE) is a neurological cirrhosis complication that may necessitate long-term specialized care. Adequate patient support and continuity of care may facilitate access to timely treatment, particularly for vulnerable populations, like Medicare patients. We described healthcare patterns and continuity of care surrounding OHE-related hospitalizations among Medicare-insured patients.
METHODS: Medicare-insured patients with an initial OHE (index) hospitalization were identified in Komodo Research Data (01/2016 - 09/2023). Care settings, including long-term care (LTC), and physician specialties providing care within 30 days before and after the index hospitalization (pre-admission/post-discharge) were described. Discontinuity of care, defined as changes in treating physicians between pre-admission and post-discharge, was assessed.
RESULTS: Of the 4,131 Medicare patients included (mean age 68.3 years, 48.8% female), the majority (53.6%) were receiving care at home pre-admission (44.8% in a community setting and 8.8% in an acute inpatient setting). However, most patients (63.8%) were discharged to LTC settings, including skilled nursing facilities (11.2%), hospice (17.7%), and home health agencies (HHA; 34.9%). Among patients admitted from home, many (45.6%) transitioned to LTC post-discharge, with a quarter (24.2%) receiving HHA care. Among patients admitted from LTC settings, most (84.9%) continued to receive care in LTC post-discharge. A minority of patients saw hepatologists (4.9% pre-admission, 7.8% post-discharge) or gastroenterologists (28.2% pre-admission, 32.8% post-discharge). Many patients (40.6%) experienced discontinuity of care around the index hospitalization.
CONCLUSIONS: Among Medicare patients, OHE is associated with a substantial LTC burden, with most receiving post-discharge care in LTC settings. This underscores the impact of OHE on patient autonomy, as many require advanced care after an initial hospitalization. Further, transition in care and provider discontinuity, coupled with low specialist involvement, may hinder patients’ adequate follow-up and treatment access. These findings highlight an unmet need for specialized, continuous care for patients with OHE.
METHODS: Medicare-insured patients with an initial OHE (index) hospitalization were identified in Komodo Research Data (01/2016 - 09/2023). Care settings, including long-term care (LTC), and physician specialties providing care within 30 days before and after the index hospitalization (pre-admission/post-discharge) were described. Discontinuity of care, defined as changes in treating physicians between pre-admission and post-discharge, was assessed.
RESULTS: Of the 4,131 Medicare patients included (mean age 68.3 years, 48.8% female), the majority (53.6%) were receiving care at home pre-admission (44.8% in a community setting and 8.8% in an acute inpatient setting). However, most patients (63.8%) were discharged to LTC settings, including skilled nursing facilities (11.2%), hospice (17.7%), and home health agencies (HHA; 34.9%). Among patients admitted from home, many (45.6%) transitioned to LTC post-discharge, with a quarter (24.2%) receiving HHA care. Among patients admitted from LTC settings, most (84.9%) continued to receive care in LTC post-discharge. A minority of patients saw hepatologists (4.9% pre-admission, 7.8% post-discharge) or gastroenterologists (28.2% pre-admission, 32.8% post-discharge). Many patients (40.6%) experienced discontinuity of care around the index hospitalization.
CONCLUSIONS: Among Medicare patients, OHE is associated with a substantial LTC burden, with most receiving post-discharge care in LTC settings. This underscores the impact of OHE on patient autonomy, as many require advanced care after an initial hospitalization. Further, transition in care and provider discontinuity, coupled with low specialist involvement, may hinder patients’ adequate follow-up and treatment access. These findings highlight an unmet need for specialized, continuous care for patients with OHE.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD106
Topic
Health Service Delivery & Process of Care
Disease
SDC: Gastrointestinal Disorders, SDC: Neurological Disorders