Recruiting

Transitional Care Program

Sponsor:

Milton S. Hershey Medical Center

Code:

NCT06174272

Conditions

Cirrhosis, Liver

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

Transitional Care Program

Study Details

Brief summary:

The goal of this clinical trial is to learn about an intensive monitoring plan (transitional care program) in patients with cirrhosis and excessive swelling that are going to be discharged from the hospital.

The main question\[s\] it aims to answer are:

  • How much time and what resources are needed to run such a program
  • How well do patients follow up with the phone calls, bloodwork, and doctor appointments?
  • Do the patients enrolled in the program have less need for hospitalization later, less kidney injury, better fluid control, and/or better survival compared to patients that are not in the program?

Participants will

  • Be given a digital scale and a binder with educational material and a log to monitor their weights after discharge from the hospital
  • Receive a phone call from the study team within 72 hours of discharge and weekly
  • Be given a follow up appointment with hepatology within 4 weeks of discharge

Researchers will compare participants in this program to patients that receive normal care to see if there are differences in need for hospitalization later, kidney injury, fluid control, and/or survival.

Conditions

Cirrhosis, Liver

Study ID

NCT06174272

Start date

Feb 15, 2025

Status verified date

Mar, 2026

Completion date

Jun 1, 2027

Anticipated

Primary completion date

Feb 15, 2027

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Patients > 18 years of age.
  • Inpatient at Penn State Health, Milton S. Hershey Medical Center.
  • Diagnosis of cirrhosis.
  • Hospitalized with fluid overload (ascites and/or significant anasarca/edema) requiring diuretic therapy.
  • English speaking

Exclusion Criteria:

  • Placement of a TIPS.
  • Ascites from an etiology other than cirrhosis, such as malignancy, heart failure, pancreatitis, nephrotic syndrome.
  • Non-English speaking

Study Design

Enrollment

20 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Supportive Care

Interventions and Outcome Measures

Arms

experimental: Transitional Care Program

Participants will receive a digital scale and monitoring log, educational material, a phone call within 72 hours of discharge and weekly for 8 weeks, and a follow up appointment with a hepatologist within 4 weeks of discharge.

no intervention: Standard of Care

Participants will be given typical discharge and follow up instructions.

Interventions

Transitional Care Program

Intensive monitoring post discharge for cirrhosis and fluid overload

Primary outcome measure

  • feasibility of the program [ Time Frame: all 8 weeks of each participant ]
  • Number of instances of weight monitoring [ Time Frame: 8 weeks for each participant ]
  • Number of successful phone calls [ Time Frame: 8 weeks for each participant ]
  • Number of follow up visits [ Time Frame: 8 weeks for each participant ]

Central Contacts and Locations

Locations

Penn State Milton S. Hershey Medical Center

Recruiting

Hershey, Pennsylvania, United States, 17033

Contacts

More Information

Sponsor

Milton S. Hershey Medical Center

Last update posted

Mar 9, 2026

Last verified

Mar, 2026

Keywords

  • ascites
  • anasarca
  • edema

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-10. This information was provided to ClinicalTrials.gov by Milton S. Hershey Medical Center on 2026-03-09.