New research project aims to address variation in care

Posted on: 14th April 2023

The British Liver Trust is supporting an exciting new project called ‘MAP-CLD: Management of Patients with Chronic Liver Disease admitted to Hospital as an Emergency’.  Led by Professor William Bernal at the Institute of Liver Studies, Kings College Hospital and Professor Jan Van der Meulen from the London School of Hygiene and Tropical Medicine, the research is investigating the medical care given to people with chronic liver disease who are admitted to hospital as an emergency.

People with liver disease often don’t know that they have it until it causes sudden health problems and they need to be admitted hospital as an emergency. People admitted in this way are often very ill, and up to a quarter of them may die within 2 months of coming into hospital. The care that they get when they are in hospital, and after being discharged, varies greatly across the country and this may have major effects on how long they survive. People with liver disease who live in the most deprived areas of England have a survival rate that is half that of people who live in the most well-off ones.

Professor William Bernal said, “Our project aims to understand how and why where people live, and what care is available to them affects the way they are treated - and their survival. If it can work out what sort of care is linked to the best survival, then it can begin to make sure that all people with liver disease get access to the best care, wherever they live’

The research will study the most important points in the ‘journey’ that people with liver disease follow after being admitted to hospital. For example, it will seek to understand why some people but not others are treated by specialist doctors or are admitted to Intensive Care Units, and how this changes depending upon what staff and facilities are available, and the background of the people who have liver disease.

The project has two major parts. One will analyse the electronic health information that is routinely recorded when people are admitted to hospital or seen in outpatients using a method called ‘Data linkage’, combining this information with a detailed map of how liver care is arranged in different hospitals. The second will be a ‘Social Science’ study where we will observe how care is given to people with liver disease when they are in hospital or in outpatients. Importantly, it will also interview people with liver disease to understand how the diagnosis has affected them and their ability to engage with medical services.  These observations and interviews will take part in hospitals in different parts of the country.

The British Liver Trust is on the project team and steering groups for the project, and has helped involve people with liver disease from the very earliest stages of its planning, so that they can influence the design of the research and the key areas of investigation. Our outreach team is working closely with the Social Scientists to help them to continue involving with people with liver disease as the project proceeds. The project is funded by NIHR.