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DOI: 10.1055/a-2684-6289
Patient-Centered Treatment of Cirrhosis

Abstract
Patient-centered care for chronic liver disease is an approach that supports patient engagement and proactive interventions aimed at preserving quality of life and function and preventing adverse outcomes. Patient-centered care is fully realized by embracing multidisciplinary care, technological innovation, and fully optimized use of the electronic health record for remote monitoring and patient communication/education. It is best enabled using conducive payment models and may require adjustments to clinical structures. This review highlights key successful examples and areas for growth applicable to practices around the world.
Publication History
Accepted Manuscript online:
18 August 2025
Article published online:
29 August 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Younossi ZM, Wong G, Anstee QM, Henry L. The global burden of liver disease. Clin Gastroenterol Hepatol 2023; 21 (08) 1978-1991
- 2 Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ 2018; 362: k2817
- 3 Desai AP, Mohan P, Roubal AM, Bettencourt R, Loomba R. Geographic variability in liver disease-related mortality rates in the United States. Am J Med 2018; 131 (07) 728-734
- 4 Hirode G, Saab S, Wong RJ. Trends in the burden of chronic liver disease among hospitalized US adults. JAMA Netw Open 2020; 3 (04) e201997
- 5 Huang DQ, Terrault NA, Tacke F. et al. Global epidemiology of cirrhosis - aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol 2023; 20 (06) 388-398
- 6 Wammes JJG, van der Wees PJ, Tanke MAC, Westert GP, Jeurissen PPT. Systematic review of high-cost patients' characteristics and healthcare utilisation. BMJ Open 2018; 8 (09) e023113
- 7 Pirhonen L, Gyllensten H, Olofsson EH. et al. The cost-effectiveness of person-centred care provided to patients with chronic heart failure and/or chronic obstructive pulmonary disease. Health Policy OPEN 2020; 1: 100005
- 8 Amin AN, Cornelison S, Woods JA, Hanania NA. Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team. Postgrad Med 2022; 134 (02) 152-159
- 9 Kalyan A, Kulik L. Multidisciplinary care in hepatocellular carcinoma: where do we go from here?. Gastroenterology 2017; 152 (08) 1823-1825
- 10 Kanwal F, Asch SM, Kramer JR, Cao Y, Asrani S, El-Serag HB. Early outpatient follow-up and 30-day outcomes in patients hospitalized with cirrhosis. Hepatology 2016; 64 (02) 569-581
- 11 Serper M, Agha A, Garren PA. et al. Multidisciplinary teams, efficient communication, procedure services, and telehealth improve cirrhosis care: a qualitative study. Hepatol Commun 2023; 7 (06) e0157
- 12 Sengupta S, Anand A, Yang Q. et al. The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: early outcomes from a multidisciplinary clinic. Hepatol Commun 2025; 9 (02) e0603
- 13 Mahle R, McLean Diaz P, Marshall C, Goodman RP, Schaefer E, Luther J. Integrated hepatology and addiction care for inpatients with alcohol use disorder improves outcomes: a prospective study. Hepatol Commun 2023; 7 (05) e0119
- 14 Blaney HL, Khalid MB, Yang AH. et al. Hepatology consultation is associated with decreased early return to alcohol use after discharge from an inpatient alcohol use disorder treatment program. Hepatol Commun 2024; 8 (05) e0414
- 15 Gupta R, Wong J, Hallinan C. et al. Is nesting addiction medicine and hepatology care in the outpatient setting worthwhile? A retrospective case series at a single tertiary center. Hepatol Commun 2024; 8 (12) e0555
- 16 Stine JG, Bradley D, McCall-Hosenfeld J. et al. Multidisciplinary clinic model enhances liver and metabolic health outcomes in adults with MASH. Hepatol Commun 2025; 9 (02) e0649
- 17 Kearney A, Tiwari N, Cullen O. et al. Improving palliative and supportive care in advanced cirrhosis: the HepatoCare model of integrated collaborative care. Intern Med J 2023; 53 (11) 1963-1971
- 18 Shaw J, Acharya C, Albhaisi S. et al. Subjective and objective burden on providers from a multicenter app-based study of patients with cirrhosis and caregivers. Hepatol Commun 2023; 7 (02) e0030
- 19 Morando F, Maresio G, Piano S. et al. How to improve care in outpatients with cirrhosis and ascites: a new model of care coordination by consultant hepatologists. J Hepatol 2013; 59 (02) 257-264
- 20 Dowlatshahi S, Koh J, Vyas A, Mack WJ, Turner BJ. Disparities in care for low-income patients with cirrhosis: implementing an innovative outpatient clinic for refractory ascites in a safety net hospital. J Gen Intern Med 2024; 39 (07) 1245-1251
- 21 Aby ES, Kaplan A, Ufere NN. Cost and value in liver disease guidelines: 2011-2022. Hepatol Commun 2023; 7 (01) e0001
- 22 Aby ES, Shen TH, Murugappan MN, Stenehjem DD, Leventhal TM. High rifaximin out-of-pocket costs are associated with decreased treatment retention among patients with hepatic encephalopathy. Hepatol Commun 2023; 7 (08) e0215
- 23 Patel K, Presser E, George M, McClellan M. Shifting away from fee-for-service: alternative approaches to payment in gastroenterology. Clin Gastroenterol Hepatol 2016; 14 (04) 497-506
- 24 O'Brien B. Principles of economic evaluation for health care programs. J Rheumatol 1995; 22 (07) 1399-1402
- 25 Desmedt M, Vertriest S, Hellings J. et al. Economic impact of integrated care models for patients with chronic diseases: a systematic review. Value Health 2016; 19 (06) 892-902
- 26 Mitchell GK, Burridge L, Zhang J. et al. Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?. Aust J Prim Health 2015; 21 (04) 391-408
- 27 Verma M, Younossi Z. Integrating patient-reported outcomes within routine hepatology care: a prompt to action. Hepatology 2021; 73 (04) 1570-1580
- 28 Verma M. Patient reported outcomes as emerging biomarkers in chronic liver disease research. J Hepatol 2020; 72 (06) 1215-1216
- 29 Basch E, Abernethy AP. Supporting clinical practice decisions with real-time patient-reported outcomes. J Clin Oncol 2011; 29 (08) 954-956
- 30 Verma M, Stites S, Navarro V. Bringing assessment of patient-reported outcomes to hepatology practice. Clin Gastroenterol Hepatol 2018; 16 (03) 447-448
- 31 Tapper EB, Parikh ND. The future of quality improvement for cirrhosis. Liver Transpl 2021; 27 (10) 1479-1489
- 32 Tapper EB. et al. The Liver Cirrhosis Network Cohort Study: cirrhosis definition, study population, and endpoints. Am J Gastroenterol 2024
- 33 Patel AA, Tapper EB, Kanwal F. et al. Targets and study design for symptom-focused trials aimed at patients with cirrhosis: an expert consensus. Hepatol Commun 2023; 7 (06) e0135
- 34 Rubin JB, Loeb R, Fenton C. et al. The burden of significant pain in the cirrhosis population: risk factors, analgesic use, and impact on health care utilization and clinical outcomes. Hepatol Commun 2024; 8 (06) e0432
- 35 Zeng C, Donlan J, Indriolo T. et al. Validation of the Hospital Anxiety and Depression Scale in patients with decompensated cirrhosis. Hepatol Commun 2024; 8 (12) e0588
- 36 Zimbrean PC, Jakab SS. Depression and anxiety management in cirrhosis. Hepatol Commun 2024; 9 (01) e0600
- 37 Holmgren AJ, Adler-Milstein J. Health information exchange in US hospitals: the current landscape and a path to improved information sharing. J Hosp Med 2017; 12 (03) 193-198
- 38 Subrahmanya SVG, Shetty DK, Patil V. et al. The role of data science in healthcare advancements: applications, benefits, and future prospects. Ir J Med Sci 2022; 191 (04) 1473-1483
- 39 Driver RJ, Balachandrakumar V, Burton A. et al. Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study. BMJ Open 2019; 9 (07) e028571
- 40 Hagström H, Adams LA, Allen AM. et al. Administrative coding in electronic health care record-based research of NAFLD: an expert panel consensus statement. Hepatology 2021; 74 (01) 474-482
- 41 Van Vleck TT, Chan L, Coca SG. et al. Augmented intelligence with natural language processing applied to electronic health records for identifying patients with non-alcoholic fatty liver disease at risk for disease progression. Int J Med Inform 2019; 129: 334-341
- 42 Wigg AJ, McCormick R, Wundke R, Woodman RJ. Efficacy of a chronic disease management model for patients with chronic liver failure. Clin Gastroenterol Hepatol 2013; 11 (07) 850-8.e1 , 4
- 43 Bloom PP, Tapper EB. Lactulose in cirrhosis: current understanding of efficacy, mechanism, and practical considerations. Hepatol Commun 2023; 7 (11) e0295
- 44 McElroy I, Sareh S, Zhu A. et al. Use of digital health kits to reduce readmission after cardiac surgery. J Surg Res 2016; 204 (01) 1-7
- 45 Mousa AY, Broce M, Monnett S, Davis E, McKee B, Lucas BD. Results of telehealth electronic monitoring for post discharge complications and surgical site infections following arterial revascularization with groin incision. Ann Vasc Surg 2019; 57: 160-169
- 46 Penrice DD, Hara KS, Sordi-Chara B. et al. Design, implementation, and impact of a cirrhosis-specific remote patient monitoring program. Hepatol Commun 2024; 8 (08) e0498
- 47 Wu T, Sherman G, Giorgi S. et al. Smartphone sensor data estimate alcohol craving in a cohort of patients with alcohol-associated liver disease and alcohol use disorder. Hepatol Commun 2023; 7 (12) e0329
- 48 Valery PC, Bernardes CM, Hayward KL. et al. Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study. BMC Gastroenterol 2022; 22 (01) 340
- 49 Verma M, Chan M, Toroghi S, Gallagher M, Lo K, Navarro V. Multimedia-based education led to improvement in disease knowledge among patients with cirrhosis. Dig Dis Sci 2024; 69 (12) 4364-4372
- 50 Au J, Falloon C, Ravi A, Ha P, Le S. A beta-prototype chatbot for increasing health literacy of patients with decompensated cirrhosis: usability study. JMIR Hum Factors 2023; 10: e42506
- 51 Che Z, Louissaint J, Kassab I, Tapper EB. Pill or procedure? Patient preferences on beta-blockers as an alternative to endoscopic variceal screening during the COVID-19 pandemic. Gastroenterol Rep (Oxf) 2022; 10: goac015
- 52 Lai JC, Ring M, Dhruva A, Yeh GY. A patient-centered approach to dietary supplements for patients with chronic liver disease. Hepatol Commun 2024; 8 (11) e0552
- 53 Tapper EB, Ospina E, Salim N, Chen X, Nikirk S. Lactulose therapy for patients with cirrhosis, portal hypertension, and poor patient-reported outcomes: the Mi-Kristal trial. Hepatology 2023; 78 (04) 1159-1167
- 54 Nadeem M, Tafader A, Park D, Fagan A, Wade JB, Bajaj JS. A specialized HE testing clinic improves rational decision-making for therapy in cirrhosis. Hepatol Commun 2023; 7 (11) e0301
- 55 Yopp AC, Mansour JC, Beg MS. et al. Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome. Ann Surg Oncol 2014; 21 (04) 1287-1295
- 56 Agarwal PD, Phillips P, Hillman L. et al. Multidisciplinary management of hepatocellular carcinoma improves access to therapy and patient survival. J Clin Gastroenterol 2017; 51 (09) 845-849
- 57 Carbonneau M, Davyduke T, Congly SE. et al. Impact of specialized multidisciplinary care on cirrhosis outcomes and acute care utilization. Can Liver J 2021; 4 (01) 38-50
- 58 Mellinger JL, Winder GS, Fernandez AC. et al. Feasibility and early experience of a novel multidisciplinary alcohol-associated liver disease clinic. J Subst Abuse Treat 2021; 130: 108396