Veteran-Centered Care for Advanced Liver Disease (Vet-CALD)

Description

Advanced liver disease is a serious illness that disproportionately affects Veterans, many of whom hope for curative liver transplantation. However, too few receive a transplant and most continue to suffer from increasing symptoms and hospitalizations. The proposed project uses a whole person, Veteran-centered approach that identifies Veterans with advanced liver disease using a population-based health management system and integrates curative and early supportive care using a telemedicine-based nurse care counselor to (1) discuss patient's understanding of illness severity and prognosis, (2) identify priorities and care preferences and (3) align curative and supportive care options to achieve patient priorities. Study outcomes include changes in (1) rates of consideration for liver transplantation, and (2) completion of serious illness discussions. Findings will inform adaptations to the intervention and facilitators for its dissemination.

Conditions

Liver Diseases

Study Overview

Study Details

Study overview

Advanced liver disease is a serious illness that disproportionately affects Veterans, many of whom hope for curative liver transplantation. However, too few receive a transplant and most continue to suffer from increasing symptoms and hospitalizations. The proposed project uses a whole person, Veteran-centered approach that identifies Veterans with advanced liver disease using a population-based health management system and integrates curative and early supportive care using a telemedicine-based nurse care counselor to (1) discuss patient's understanding of illness severity and prognosis, (2) identify priorities and care preferences and (3) align curative and supportive care options to achieve patient priorities. Study outcomes include changes in (1) rates of consideration for liver transplantation, and (2) completion of serious illness discussions. Findings will inform adaptations to the intervention and facilitators for its dissemination.

Integrating Veteran-Centered Care for Advanced Liver Disease (I-VCALD)

Veteran-Centered Care for Advanced Liver Disease (Vet-CALD)

Condition
Liver Diseases
Intervention / Treatment

-

Contacts and Locations

Little Rock

Central Arkansas Veterans Healthcare System , Little Rock, AR, Little Rock, Arkansas, United States, 77205

Palo Alto

VA Palo Alto Health Care System, Palo Alto, CA, Palo Alto, California, United States, 94304-1207

West Los Angeles

VA Greater Los Angeles Healthcare System, West Los Angeles, CA, West Los Angeles, California, United States, 90073-1003

Houston

Michael E. DeBakey VA Medical Center, Houston, TX, Houston, Texas, United States, 77030-4211

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * Patients will be between 18 and 80 years of age
  • * Patients must be Veterans
  • * Patients must have been in care at one of the recruiting sites for 1 year with two or more encounters in primary care
  • * Patients must have AdvLD, defined based on two ambulatory or one inpatient encounter ICD-10 codes for new onset cirrhosis complications or MELD-Na \>15 in the previous 12 months
  • * Non-Veteran patients
  • * Patients who do not speak English, do not have access to a telephone or computers, or who are unable to complete a valid informed consent form after three attempts
  • * Patients who have already made significant progress toward our endpoints: a) with prior history of liver transplantation, or b) on the liver transplant waiting list, or c) had formal evaluation for liver transplantation in the past 3 years
  • * Patients with very limited life expectancy (advanced cancer, acute-on-chronic liver failure, and hospice patients)
  • * Patients hospitalized, or in long term facilities or nursing homes at the time they meet inclusion criteria
  • * Patients with chart diagnosis of uncontrolled mental health or schizophrenia

Ages Eligible for Study

18 Years to 80 Years

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

VA Office of Research and Development,

Fasiha Kanwal, MD MSHS, PRINCIPAL_INVESTIGATOR, Michael E. DeBakey VA Medical Center, Houston, TX

Study Record Dates

2027-09-30