Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Joan A. Kearney

Abstract

Chronic Liver Disease (CLD) is one of the top causes of morbidity and mortality globally. Among the spectrum of liver diseases, non-alcoholic steatohepatitis (NASH) is the most common cause of cirrhosis and one of the top reasons for a liver transplant. Patients with NASH end up with hepatic decompensation and liver-related complications such as malnutrition, sarcopenia, frailty, and death. Telemedicine has transformed health care by improving access, reducing cost, and increasing the quality of care. However, telemedicine has not been widely used to manage patients with CLD. This DNP project created a telemedicine protocol to manage patients with NASH, implemented the project at a transplant facility, and evaluated the effectiveness of the intervention using preliminary data from visits one and two. Although a larger sample size and longer study duration are needed, the telemedicine protocol appears to improve patient clinical outcomes as evidenced by a significant decrease in weight and BMI, fewer liver-related hospitalizations, no ED or urgent care visits, and improvement on patients’ perception of activity level and worry score. No significant changes noted in the patients’ MELD-Na score, overall health-related quality of life, frailty, and malnutrition status.

Comments

This is an Open Access Thesis.

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