Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: A Research Protocol (Preprint)

Abstract

Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increased number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplants. The LT clinic at Centre Hospitalier de l’Université de Montréal (CHUM) is developing a new healthcare model across the entire continuum of pre-, per-, and post-transplant care that features patient monitoring by an interdisciplinary team including an accompanying patient (AP), a digital platform to host a clinical plan, a learning program, and data collection from connected objects (COs).

(1) To evaluate the outcomes following the implementation of a patient platform with connected devices and an AP, (2) to identify implementation barriers and facilitators, (3) to describe service outcomes in terms of health outcomes and the rates and nature of contact with the AP, (4) to describe patient outcomes, and (5) to assess the intervention’s cost-effectiveness.

Six types of participants will be included in the study: (a) patients who received transplants and reached one-year post-transplantation before September 2023 (historical cohort/control group); (b) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group); (c) relatives of those patients; (d) APs who have received an LT and are interested in supporting patients who will receive an LT; (e) healthcare professionals; and (f) decision-makers. In order to describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, AP logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study.

Five working committees (steering, education, clinical-technological, nurse-prescriptions, and AP committees) have been established for the study. Recruitment of patients is expected to start in November 2023. All the questionnaires and technological platforms have been prepared and the clinicians, stakeholders, and AP personnel have been recruited.

The implementation of this model in the trajectory of LT recipients at CHUM may allow for better monitoring and health of transplant patients, and ultimately reduce the average length of hospital stay and promote better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at CHUM and across Quebec (potentially affecting 888 patients/year), it but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision-makers and will serve as a model for other initiatives involving accompanying patients, COs or interactive platforms.