LivR Well, a 28-day, community-based liver rehabilitation program for patients with acute-on-chronic liver failure: A feasibility study.

Background and Aim: Acute-on-chronic liver failure (ACLF) is associated with a rising global health care burden, including a 30-day readmission rate of 30%-42%1 and 30-day mortality ranging from 27% with single organ failure to 77% in four-organ failures.2 Compared with other chronic conditions, such as heart failure, patients with ACLF have reduced access to integrated ambulatory care services,3 and care is fragmented through under-resourced outpatient clinics. LivR Well, a coordinated, multidisciplinary, 28-day program comanaged through a decompensated liver clinic and the Monash Health Hospital in the Home (HITH) unit, has been developed and piloted. LivR Well's key objectives are to improve patient outcomes and disease-related quality of life and alleviate resource burden. The aim of this study was to determine program feasibility before undertaking a randomized controlled trial. Method(s): A feasibility study was performed, enrolling patients with ACLF into a coordinated, multidisciplinary, ambulatory care program managed through Monash Health HITH. Adult patients were eligible for enrolment if they were recently discharged from an acute hospital admission with ACLF and required evaluation and management by >=3 allied health clinicians (nurse, dietitian, physiotherapist, social worker, and/or pharmacist). ACLF was defined as an acute hepatic insult with jaundice and coagulopathy (serum bilirubin level >= 50 mmol/L and international normalized ratio >= 1.5) complicated within 4 weeks by ascites and/or encephalopathy. Patients were excluded if they were receiving terminal care or heart failure management, were unable to provide informed consent, or were residents of aged care facilities. Data including blood tests and patient-reported outcome measures were collected on Day 1 and Day 28 and at 6 weeks from enrolment. The outcomes to be assessed included patient characteristics, change in Model for End-Stage Liver Disease (MELD) score and Child- Pugh class, patient