A24 SPECIALIZED MULTIDISCIPLINARY CARE IN CIRRHOSIS IMPROVES MORTALITY AND REDUCES ACUTE CARE UTILIZATION
Bibliographic record
Abstract
As the prevalence of cirrhosis-associated acute care utilization and mortality rise, new care models are emerging. The impact of multidisciplinary care on survival and acute care utilization is limited to one study, showing benefit. The cirrhosis care clinic (CCC) at the University of Alberta Hospital offers outpatient multidisciplinary care to patients with cirrhosis. We aimed to evaluate the acute care utilization and survival outcomes of patients followed by the CCC compared to standard care (SOC). We performed a retrospective chart review for 294 cirrhotic patients admitted at the University of Alberta Hospital between 2014 and 2015. Patients were included in the CCC group if they had been followed through the CCC prior to their baseline admission and patients never seen in the CCC were included in the SOC group (CCC=44, SOC=250). For the 243 survivors of the initial admission (CCC n=38, SOC n=205), re-admission time spent in hospital was collected until one-year post admission, death, or liver transplant. Patients from the CCC group had more advanced liver disease as shown by a higher prevalence of ascites, encephalopathy, and varices. However, acute care utilization was significantly lower in patients followed through the CCC with a reduction in both length of stay by a mean 6.06 days (p 0.01) and percent of transplant free survival days spent in hospital (15.7% vs 22.7%, p 0.037). CCC patients also had improved one-year transplant free survival versus SOC, with an adjusted one-year relative risk reduction of 51% (p 0.033). In conclusion, for patients admitted with cirrhosis, specialized multidisciplinary outpatient care is associated with a shortened length of stay, decreased subsequent need for acute care utilization, and improved one-year transplant free survival probability. Adjusted Predictors of Death or Transplantation Unadjusted Transplant Free Survival None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".