Digestive Diseases and Sciences

, Volume 60, Issue 12, pp 3563–3569

An Automated Telephone Monitoring System to Identify Patients with Cirrhosis at Risk of Re-hospitalization

  • Mary Thomson
  • Michael Volk
  • Hyungjin Myra Kim
  • John D. Piette
Original Article

DOI: 10.1007/s10620-015-3744-3

Cite this article as:
Thomson, M., Volk, M., Kim, H.M. et al. Dig Dis Sci (2015) 60: 3563. doi:10.1007/s10620-015-3744-3


Background and Aims

Hospitalizations for cirrhosis are costly and associated with increased mortality. Disease management outside of clinic, such as the use of interactive voice response (IVR) calls, may identify signs to prevent hospitalization. The aim of this study was to investigate whether IVR monitoring can predict hospitalization and mortality in cirrhosis.


One hundred patients with decompensated cirrhosis were enrolled in this observational study, of which 79 patients were included in the final analysis. Participants were followed until death, transplant, or last clinical follow-up (range 7–874 days). Analysis focused on potential predictors identified during the first month of IVR calls: presence of jaundice, abdominal/leg swelling, weakness, paracentesis requirement, medication changes, and weight change. The primary outcome was time to first hospital admission; secondary outcomes included hospitalization and time to death. Potential predictors with a p value <0.1 were further analyzed after adjustment for covariates (Model for End-stage Liver Disease score, serum sodium, number of medications).


Twenty (25 %) patients died, and 49 (62 %) were hospitalized at least once. Fifty-six (70 %) patients completed >80 % of their IVR calls. After adjustment for covariates, weakness was associated with an increased risk of first hospitalization (HR 2.14, CI 1.13–4.05, p = 0.02) and hospitalization rate (HR 2.1, CI 1.0–4.3, p = 0.048). Weight change of ≥five pounds (2.3 kg) in a week increased the rate of hospitalization by 2.7 (CI 1.0–7.1, p = 0.045). No variable predicted death after covariate adjustment.


These results suggest IVR calls can be used to predict hospitalization in cirrhosis.


Telemedicine Cirrhosis Patient care management Hospitalization 

Funding information

Funder NameGrant NumberFunding Note
National Institute of Diabetes and Digestive and Kidney Diseases
  • K23DK085204
National Institute of Diabetes and Digestive and Kidney Diseases
  • P30DK092926

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.Loma Linda University Medical Center Transplantation InstituteLoma LindaUSA
  4. 4.Center for Statistical Consultation and ResearchUniversity of MichiganAnn ArborUSA
  5. 5.Health Services Research and Development Center for Clinical Management ResearchDepartment of Veterans AffairsAnn ArborUSA
  6. 6.Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA

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