# Developing technology-based approaches to improve access and quality of care in cirrhosis

> **NIH NIH K23** · UNIVERSITY OF PENNSYLVANIA · 2020 · $193,517

## Abstract

PROJECT SUMMARY
Liver cirrhosis affects greater than 5 million individuals in the United States. Recent national data show a 59%
increase in cirrhosis prevalence and a 52% increase in cirrhosis mortality from 2001-2013. Despite effective
hepatitis C (HCV) eradication with new direct-acting antivirals, the burden of chronic liver disease and
hepatocellular carcinoma will continue to rise, resulting in up to $10.6 billion in annual health care costs.
Cirrhosis management is highly complex and requires specialized training, however, due to workforce
shortages, 82% of cirrhosis-related hospitalizations occur at non-transplant hospitals and only 45% of cirrhotic
patients see a gastroenterologist or hepatologist within one year of hospitalization. Overcoming barriers to
access to specialty care may be feasible with telehealth, which has shown promise in HCV treatment, HIV, and
other chronic diseases, however, this approach has not been rigorously investigated in cirrhosis.
 The proposed research fills gaps in cirrhosis care management through the following innovations: 1)
identifying modifiable barriers to high quality cirrhosis care using the largest, multi-center database to date; 2)
tailoring a telehealth program specific to cirrhosis using implementation science principles for rapid adoption
into clinical practice; and 3) delivering a telehealth intervention to geographically distant and diverse sites. The
hypothesis that telehealth may improve the access and quality of care in cirrhosis will be pursued through the
following interrelated Specific Aims: (1) investigate how access to specialty care impacts process of care and
clinical outcomes among a national VA cohort, (2) conduct qualitative interviews to explore barriers and
facilitators of access to care and potential uses for telehealth among clinicians at low and high specialty-care-
access sites, and (3) pilot-test a telehealth intervention to provide timely hepatology care to patients with
cirrhosis complications at two community hospitals, and enhance non-expert provider training through problem-
based learning. The project aims will identify modifiable factors to improve the delivery of high-quality care for
cirrhosis and establish the feasibility of a telehealth strategy to increase access to specialty care.
 The PI is Assistant Professor of Medicine, a hepatologist, and hypothesis-driven clinical researcher at
the University of Pennsylvania. Her experience in patient-oriented and observational research and a Master's
in Health Services and Outcomes Research have prepared her to execute the project aims. The proposed
research will be combined with carefully structured mentorship by faculty with complementary expertise,
institutional support, and coursework in advanced observational methods, clinical trials, information technology,
and implementation science. This award and protected time will allow the applicant to build an independent
NIH-funded research career and become a leader in tec...

## Key facts

- **NIH application ID:** 9857011
- **Project number:** 5K23DK115897-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Marina Serper
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $193,517
- **Award type:** 5
- **Project period:** 2018-04-01 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9857011

## Citation

> US National Institutes of Health, RePORTER application 9857011, Developing technology-based approaches to improve access and quality of care in cirrhosis (5K23DK115897-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9857011. Licensed CC0.

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