{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:32:00Z","timestamp":1793334720070,"version":"4.5.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patients with complications of advanced liver disease experience high rates of hospital readmission after discharge. Transitional care models have improved outcomes in other chronic conditions, but their efficacy in liver disease care remains uncertain. This randomized trial evaluates the effectiveness of a tailored transitional care model\u2014the Transitional Liver Clinic (TLC)\u2014in reducing readmissions, improving quality of life, and enhancing patient satisfaction for patients with advanced liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a 45-month, stepped-wedge cluster randomized trial enrolling up to 1000 patients with advanced liver disease across 4 academic medical centers. Each site transitions from usual care to the TLC intervention on a randomized schedule at 9-month intervals. The TLC includes a post-discharge phone call within 2 business days and a hepatology advanced practice provider (APP) visit within 14 days. The primary outcome is 30-day hospital readmission. Secondary outcomes include 90-day readmission, emergency room visits, mortality, days alive out of hospital, quality of life, and patient satisfaction. Quality of life is measured with the PROMIS-29+2 Profile, and patient satisfaction is measured with the Patient Satisfaction Questionnaire-18. Follow-up occurs at 30 and 90 days post-discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This multicenter randomized trial will determine whether a structured, APP-led transitional care model can improve outcomes for patients with advanced liver disease. If successful, the TLC could serve as a scalable model for post-discharge care in hepatology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/hc9.0000000000000990","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:01:19Z","timestamp":1781874079000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The Transitional Liver Clinic: Study protocol for a stepped-wedge cluster randomized trial"],"prefix":"10.1097","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6556-1162","authenticated-orcid":false,"given":"Lindsay","family":"Yoder","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0839-1515","authenticated-orcid":false,"given":"Elliot B.","family":"Tapper","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2248-5032","authenticated-orcid":false,"given":"Richard","family":"Kalman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology and Hepatology, Jefferson Einstein Philadelphia Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0620-9705","authenticated-orcid":false,"given":"Mary","family":"Rinella","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Hepatology & Nutrition, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Bendin","sequence":"additional","affiliation":[{"name":"Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6328-7155","authenticated-orcid":false,"given":"Manisha","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Gastroenterology and Hepatology, Jefferson Einstein Philadelphia Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1092-6329","authenticated-orcid":false,"given":"Francis","family":"Pike","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4082-3178","authenticated-orcid":false,"given":"Naga","family":"Chalasani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Nalumasu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8295-9076","authenticated-orcid":false,"given":"Eric S.","family":"Orman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"key":"R1-20261030","doi-asserted-by":"crossref","first-page":"e00062","DOI":"10.14309\/ctg.0000000000000062","article-title":"Increasing economic burden in hospitalized patients with cirrhosis: Analysis of a national database","volume":"10","author":"Desai","year":"2019","journal-title":"Clin Transl Gastroenterol"},{"key":"R2-20261030","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1002\/hep.28900","article-title":"A Karnofsky performance status-based score predicts death after hospital discharge in patients with cirrhosis","volume":"65","author":"Tandon","year":"2017","journal-title":"Hepatology"},{"key":"R3-20261030","doi-asserted-by":"crossref","first-page":"575","DOI":"10.14309\/ajg.0000000000000545","article-title":"Health-related quality of life: A rapid predictor of hospitalization in patients with cirrhosis","volume":"115","author":"Kok","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"R4-20261030","doi-asserted-by":"crossref","first-page":"490","DOI":"10.12788\/jhm.2967","article-title":"Hospital readmissions in patients with cirrhosis: A systematic review","volume":"13","author":"Orman","year":"2018","journal-title":"J Hosp Med"},{"key":"R5-20261030","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1038\/ajg.2011.314","article-title":"Hospital readmissions among patients with decompensated cirrhosis","volume":"107","author":"Volk","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"R6-20261030","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/MCG.0000000000001202","article-title":"Incidence and risk factors associated with 30-day readmission for alcoholic hepatitis","volume":"53","author":"Garg","year":"2019","journal-title":"J Clin Gastroenterol"},{"key":"R7-20261030","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.cgh.2019.04.048","article-title":"Alcohol rehabilitation within 30 days of hospital discharge is associated with reduced readmission, relapse, and death in patients with alcoholic hepatitis","volume":"18","author":"Peeraphatdit","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R8-20261030","doi-asserted-by":"crossref","first-page":"287","DOI":"10.14309\/ajg.0000000000002455","article-title":"Thirty-day readmissions are largely not preventable in patients with cirrhosis","volume":"119","author":"Orman","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"R9-20261030","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1001\/jamainternmed.2014.1608","article-title":"Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials","volume":"174","author":"Leppin","year":"2014","journal-title":"JAMA Intern Med"},{"key":"R10-20261030","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1377\/hlthaff.2011.0041","article-title":"The care span: The importance of transitional care in achieving health reform","volume":"30","author":"Naylor","year":"2011","journal-title":"Health affairs"},{"key":"R11-20261030","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1161\/HHF.0000000000000006","article-title":"Transitions of care in heart failure: A scientific statement from the American Heart Association","volume":"8","author":"Albert","year":"2015","journal-title":"Circ Heart Fail"},{"key":"R12-20261030","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1001\/archinte.166.17.1822","article-title":"The care transitions intervention: Results of a randomized controlled trial","volume":"166","author":"Coleman","year":"2006","journal-title":"Arch Intern Med"},{"key":"R13-20261030","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.4187\/respcare.06959","article-title":"Effects of transitional care on hospital readmission and mortality rate in subjects with COPD: A systematic review and meta-analysis","volume":"64","author":"Ridwan","year":"2019","journal-title":"Respir Care"},{"key":"R14-20261030","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1001\/jamainternmed.2018.2572","article-title":"Changes in health care costs and mortality associated with transitional care management services after a discharge among medicare beneficiaries","volume":"178","author":"Bindman","year":"2018","journal-title":"JAMA Intern Med"},{"key":"R15-20261030","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.amjmed.2021.09.016","article-title":"Attendance at a Transitional Liver Clinic may be associated with reduced readmissions for patients with liver disease","volume":"135","author":"Yoder","year":"2022","journal-title":"Am J Med"},{"key":"R16-20261030","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/1062860615615426","article-title":"Systematic review of ambulatory transitional care management (TCM) visits on hospital 30-day readmission rates","volume":"32","author":"Roper","year":"2017","journal-title":"Am J Med Qual"},{"key":"R17-20261030","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"R18-20261030","doi-asserted-by":"crossref","first-page":"324","DOI":"10.7326\/M16-0185","article-title":"Readmission rates after passage of the hospital readmissions reduction program: A pre-post analysis","volume":"166","author":"Wasfy","year":"2017","journal-title":"Ann Intern Med"},{"key":"R19-20261030","first-page":"75","article-title":"Identifying potentially preventable readmissions","volume":"30","author":"Goldfield","year":"2008","journal-title":"Health Care Financ Rev"},{"key":"R20-20261030","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ahj.2021.04.016","article-title":"Seeking patient-centered trial outcomes: The case for days alive out of hospital","volume":"248","author":"Faggioni","year":"2022","journal-title":"Am Heart J"},{"key":"R21-20261030","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1007\/s11136-018-1842-3","article-title":"PROMIS(\u00ae)-29 v2.0 profile physical and mental health summary scores","volume":"27","author":"Hays","year":"2018","journal-title":"Qual Life Res"},{"key":"R22-20261030","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.2215\/CJN.01880221","article-title":"Evaluation of PROMIS Preference Scoring System (PROPr) in patients undergoing hemodialysis or kidney transplant","volume":"16","author":"Zhang","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"R23-20261030","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.1097\/HEP.0000000000000480","article-title":"PROMIS Profile-29 is a valid instrument with distinct advantages over legacy instruments for measuring the quality of life in chronic liver disease","volume":"78","author":"Desai","year":"2023","journal-title":"Hepatology"},{"key":"R24-20261030","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/j.1365-2036.2011.04842.x","article-title":"PROMIS computerised adaptive tests are dynamic instruments to measure health-related quality of life in patients with cirrhosis","volume":"34","author":"Bajaj","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"key":"R25-20261030","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1007\/s10620-017-4509-y","article-title":"Symptom domain groups of the patient-reported outcomes measurement information system tools independently predict hospitalizations and re-hospitalizations in cirrhosis","volume":"62","author":"Patidar","year":"2017","journal-title":"Dig Dis Sci"},{"key":"R26-20261030","doi-asserted-by":"crossref","first-page":"e0727","DOI":"10.1097\/HC9.0000000000000727","article-title":"Meaningful differences in patient-reported outcome measurement scores in liver disease","volume":"9","author":"Desai","year":"2025","journal-title":"Hepatol Commun"},{"key":"R28-20261030","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/geront\/38.3.303","article-title":"Satisfaction with outpatient geriatric evaluation and management (GEM)","volume":"38","author":"Morishita","year":"1998","journal-title":"Gerontologist"},{"key":"R29-20261030","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/2374373517750413","article-title":"Satisfaction with health care among patients navigated for preventive cancer screening","volume":"5","author":"Hermann","year":"2018","journal-title":"J Patient Exp"},{"key":"R30-20261030","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1007\/s10620-018-5397-5","article-title":"Patient satisfaction and healthcare utilization using telemedicine in liver transplant recipients","volume":"64","author":"Le","year":"2019","journal-title":"Dig Dis Sci"},{"key":"R31-20261030","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.cct.2006.05.007","article-title":"Design and analysis of stepped wedge cluster randomized trials","volume":"28","author":"Hussey","year":"2007","journal-title":"Contemp Clin Trials"},{"key":"R32-20261030","doi-asserted-by":"crossref","first-page":"4718","DOI":"10.1002\/sim.7028","article-title":"Sample size calculation for stepped wedge and other longitudinal cluster randomised trials","volume":"35","author":"Hooper","year":"2016","journal-title":"Stat Med"},{"key":"R33-20261030","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1177\/0962280217734981","article-title":"Impact of non-uniform correlation structure on sample size and power in multiple-period cluster randomised trials","volume":"28","author":"Kasza","year":"2019","journal-title":"Stat Methods Med Res"},{"key":"R34-20261030","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1037\/1082-989X.7.2.147","article-title":"Missing data: Our view of the state of the art","volume":"7","author":"Schafer","year":"2002","journal-title":"Psychol Methods"},{"key":"R35-20261030","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1080\/01621459.1995.10476615","article-title":"Modeling the drop-out mechanism in repeated-measures studies","volume":"90","author":"Little","year":"1995","journal-title":"J Am Stat Assoc"},{"key":"R36-20261030","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1037\/1082-989X.2.1.64","article-title":"Application of random-effects pattern-mixture models for missing data in longitudinal studies","volume":"2","author":"Hedeker","year":"1997","journal-title":"Psychol Methods"},{"key":"R37-20261030","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.jhep.2013.03.010","article-title":"How to improve care in outpatients with cirrhosis and ascites: A new model of care coordination by consultant hepatologists","volume":"59","author":"Morando","year":"2013","journal-title":"J Hepatol"},{"key":"R38-20261030","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.dld.2017.08.024","article-title":"HEPACONTROL. A program that reduces early readmissions, mortality at 60 days, and healthcare costs in decompensated cirrhosis","volume":"50","author":"Morales","year":"2018","journal-title":"Dig Liver Dis"},{"key":"R40-20261030","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1186\/1745-6215-15-456","article-title":"Reducing bias in open-label trials where blinded outcome assessment is not feasible: Strategies from two randomised trials","volume":"15","author":"Kahan","year":"2014","journal-title":"Trials"},{"key":"R41-20261030","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1053\/j.gastro.2016.02.042","article-title":"Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia","volume":"150","author":"Crabb","year":"2016","journal-title":"Gastroenterology"}],"container-title":["Hepatology Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/HC9.0000000000000990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:00:14Z","timestamp":1793332814000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/HC9.0000000000000990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":39,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/hc9.0000000000000990","relation":{},"ISSN":["2471-254X"],"issn-type":[{"value":"2471-254X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"2026-02-22","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}