B0513 - Gender and Ethnicity Are Predictors of Liver-Related Rehospitalizations in Patients With Hepatic Encephalopathy When Rifaximin Is Delivered Within 30 Days of Hospital Discharge

Eugene C. Nwankwo, MD, David Annakie, MBA, Jay Shah, DO, MS, Ritika Jain, BS, Kamran Qureshi, MD
Saint Louis University, St. Louis, MO

Introduction: Hepatic Encephalopathy (HE) has high rate of recurrence and early hospitalizations in Liver Cirrhosis (LC). Rifaximin reduces HE recurrence and hospitalizations, but patients may not receive it timely due to difficulty obtaining prior authorization for insurance approval, or high co-payments. These issues disproportionately affect patients from underrepresented backgrounds and lower socioeconomic status. This study shows preliminary results of our Quality Improvement (QI) project where we provided initial fill of Rifaximin at the bedside prior to discharge and/or early delivery of outpatient refills after discharge.

Methods: Group-A (Intervention) was prospectively enrolled in QI project database - during Jan 2019 to Dec 2021. We performed retrospective analysis of patients admitted with recurrent HE. 30-day and 60-day liver-related hospitalizations were recorded for patients who had Rifaximin added during index hospitalization. Control (Group-B) was identified from historical readmission data at our center during November 1, 2018, to January 1, 2019, as patients who were written Rifaximin prescription at time of discharge, prior to initiation of our QI project.

Results: 80 patients constituted Group A - 23 received Rifaximin at the bedside (39% female) prior to discharge and 57 (19% female) received it within 30 days of discharge from hospitalization. 44 patients constituted Group-B. Proportion of patients readmitted within 30 days was lower in Group-A compared to Group-B (48% vs 73%; p=0.002).



In 60 days after discharge, proportion of Group-A patients needing readmission was 56% compared to 73% (p=0.007). 12% of patients (n=10) had no readmissions. Males had a 16% reduction in 30-day readmission, and 45% reduction in 60-day readmissions. Female patients had 52% reduction in 30-day readmission, and 75% reduction in 60-day readmission. African American, Caucasian, and Hispanic patients showed 11%, 33%, and 71% reduction in 30-day rehospitalization, and 59%, 53%, and 64% reduction in 60-day rehospitalizations (Table 1).

Discussion: Proactively working on the insurance coverage and cost of payment incurred to the patients for Rifaximin at the time of hospital discharge will reduce early readmissions. Hospitals should utilize the opportunity during each hospitalization to alleviate disparities in admission caused by poor access to Rifaximin. Thus, providing equitable healthcare to all patients who need Rifaximin for chronic control of recurrent symptoms of HE.



Disclosures:


Eugene C. Nwankwo, MD, David Annakie, MBA, Jay Shah, DO, MS, Ritika Jain, BS, Kamran Qureshi, MD. B0513 - Gender and Ethnicity Are Predictors of Liver-Related Rehospitalizations in Patients With Hepatic Encephalopathy When Rifaximin Is Delivered Within 30 Days of Hospital Discharge, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.