<i>Hepatology at home</i>: a novel pathway for the integrated management of patients with liver disease in the home

Objective Hospital admissions and deaths due to liver disease are increasing worldwide, representing a significant burden on acute services. We describe the first 12 months of Hepatology at home , a novel service that delivers hospital-level care to patients with liver disease in their own home as an alternative to ambulatory or inpatient management. The primary aim was to evaluate the number of at-home days where a patient received assessment and management at home rather than attending hospital. Method Processes of care and outcomes of patients referred to Hepatology at Home at Oxford University Hospitals NHS Foundation Trust, United Kingdom were collected prospectively for 12 months from 27 April 2024 to 26 April 2025. Results 40 patients (n=16 female, median age 67) with 67 discrete episodes of care were referred. Most patients (90%) had cirrhosis associated with metabolic and/or alcohol risk factors. The most common reason for referral was the management of ascites/oedema (62.7%). Interventions performed in the home included ascitic tap (n=5), large volume paracentesis (n=5), venesection (n=6) and administration of intravenous iron, diuretics or antibiotics (n=13). Patients had an additional 269 days at home (per-patient median 5, range 1–72), of which 156 replaced inpatient hospital days and 113 replaced hospital-based ambulatory hepatology reviews. Within 30 days of discharge, 58.7% required a further Hepatology at home encounter or inpatient admission. The 30-day mortality rate was 32.5%. There were no unexpected deaths. Conclusion Hepatology at Home is an alternative to hospital-based ambulatory or inpatient care for patients with liver disease.