Care for Vulnerable Populations with Chronic Liver Disease: A Safety-Net Perspective.
Mark C WangSaroja BangaruKali ZhouPublished in: Healthcare (Basel, Switzerland) (2023)
Safety-net hospitals (SNHs) and facilities are the cornerstone of healthcare services for the medically underserved. The burden of chronic liver disease-including end-stage manifestations of cirrhosis and liver cancer-is high and rising among populations living in poverty who primarily seek and receive care in safety-net settings. For many reasons related to social determinants of health, these individuals often present with delayed diagnoses and disease presentations, resulting in higher liver-related mortality. With recent state-based policy changes such as Medicaid expansion that impact access to insurance and critical health services, an overview of the body of literature on SNH care for chronic liver disease is timely and informative for the liver disease community. In this narrative review, we discuss controversies in the definition of a SNH and summarize the known disparities in the cascade of the care and management of common liver-related conditions: (1) steatotic liver disease, (2) liver cancer, (3) chronic viral hepatitis, and (4) cirrhosis and liver transplantation. In addition, we review the specific impact of Medicaid expansion on safety-net systems and liver disease outcomes and highlight effective provider- and system-level interventions. Lastly, we address remaining gaps and challenges to optimizing care for vulnerable populations with chronic liver disease in safety-net settings.
Keyphrases
- healthcare
- affordable care act
- palliative care
- health insurance
- public health
- quality improvement
- mental health
- primary care
- pain management
- physical activity
- systematic review
- metabolic syndrome
- drug induced
- type diabetes
- cardiovascular disease
- climate change
- insulin resistance
- cardiovascular events
- genetic diversity
- glycemic control