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.
","abstract_html":"<p>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.</p>","abstract_has_math":false,"creators":["Ramirez, Samantha"],"institution":null,"degree_name":"Doctor of Nursing Practice (DNP)","degree_level":"Open Access Thesis","degree_discipline":"Yale University School of Nursing","degree_department":null,"school":null,"contributors":["Joan A. Kearney"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2022,"date_issued":"2022-01-01T08:00:00Z","date_published":"2022-01-01T08:00:00Z","updated_at":"2026-07-24T06:16:14Z","subjects":["Cirrhosis, Hepatology, Liver, Nonalcoholic steatohepatitis, Telemedicine, Transplant"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://elischolar.library.yale.edu/ysndt/1139","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Joan A. Kearney"]},{"key":"dc:creator","label":"Author","values":["Ramirez, Samantha"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"thesis:degree_discipline","label":"Discipline","values":["Yale University School of Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Open Access Thesis"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Nursing Practice (DNP)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Cirrhosis, Hepatology, Liver, Nonalcoholic steatohepatitis, Telemedicine, Transplant"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://elischolar.library.yale.edu/ysndt/1139"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["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.
"]},{"key":"dc:title","label":"Title","values":["Using Telemedicine To Optimize The Delivery Of Care In Patients With Liver Disease"]}]}],"canonical_facts":{"dc:contributor":["Joan A. Kearney"],"dc:creator":["Ramirez, Samantha"],"dc:description.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.
"],"dc:identifier":["https://elischolar.library.yale.edu/ysndt/1139"],"dc:subject":["Cirrhosis, Hepatology, Liver, Nonalcoholic steatohepatitis, Telemedicine, Transplant"],"dc:title":["Using Telemedicine To Optimize The Delivery Of Care In Patients With Liver Disease"],"thesis:degree_discipline":["Yale University School of Nursing"],"thesis:degree_level":["Open Access Thesis"],"thesis:degree_name":["Doctor of Nursing Practice (DNP)"]},"updated_at":"2026-07-24T06:16:14Z"}