Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients

Abstract

Background: Evidence regarding the effect of psychosocial factors on hospital readmission in the setting of hemodialysis is limited. We examined whether social worker-assessed factors were associated with 30-day readmission among prevalent hemodialysis patients. Methods: Data on 14 factors were extracted from the first available psychosocial assessment performed by social workers at three metropolitan Atlanta dialysis centers. Index admissions (first admission preceded by ≥30 days without a previous hospital discharge) were identified in the period 2/1/10-12/31/14, using linked national administrative hospitalization data. Readmission was defined as any admission within 30 days after index discharge. Associations of each of the psychosocial factors with readmission were assessed using multivariable logistic regression with adjustment for patient and index admission characteristics. Results: Among 719 patients with index admissions, 22.1% were readmitted within 30 days. No psychosocial factors were statistically significantly associated with readmission risk. However, history of substance abuse vs. none was associated with a 29% higher risk of 30-day readmission [OR: 1.29, 95% CI: 0.75-2.23], whereas depression/anxiety was associated with 20% lower risk [OR: 0.80, 95% CI: 0.47-1.36]. Patients who were never married and those who were divorced, or widowed had 38 and 17% higher risk of 30-day readmission, respectively, than those who were married [OR: 1.38, 95% CI: 0.84-2.72; OR: 1.17, 95% CI: 0.73-1.90]. Conclusions: Results suggest that psychosocial issues may be associated with risk of 30-day readmission among dialysis patients. Despite the limitations of lack of generalizability and potential misclassification due to patient self-report of psychosocial factors to social workers, further study is warranted to determine whether addressing these factors through targeted interventions could potentially reduce readmissions among hemodialysis patients.

A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study

“…Third, some suggested changes to the system may have increased its use but were very labor intensive for our initial, limited pilot, including adding the ability for dialysis providers to start a hospitalization event when they send the patient to the hospital and incorporate information from the emergency department. Fourth, DialysisConnect was developed without patient or surrogate input and was unlikely to address the sociodemographic factors associated with hospital readmission in previous studies [ 26 , 27 ]. Fifth, system use logs are temporary and potentially helpful information, such as pages visited more frequently, SMS text messages versus email preferences for alerts, and access via mobile versus web browsers, which cannot be determined; for future studies, these and similar systems could be modified to create permanent logs of system use to better inform implementation.…”

Effectiveness of a Web-Based Provider Communications Platform in Reducing Hospital Readmissions Among Patients Receiving Dialysis: A Pilot Pre-Post Study

“…1 About one-third of hospitalizations in dialysis patients are followed by a readmission within 30 days 1 ; with the exception of previous readmission, kidney failure is the strongest risk factor for readmission among Medicare beneficiaries. 2 Furthermore, such readmissions are most likely among those for whom patient-driven care coordination is most challenged, [3][4][5][6] and readmissions in this population are associated with poor subsequent outcomes, including mortality. 7,8 With the primary goals of improving patient outcomes and reducing costs, the Centers for Medicare & Medicaid Services prioritized reduction of hospital readmissions in dialysis patients via payment incentives for both hospitals and outpatient dialysis facilities.…”

Solo but Not Alone: An Examination of Social and Help Networks among Community-Dwelling Older Adults without Close Family

“…Lack of family/friend or other unpaid caregivers correlates to disparate access to care and outcomes: Single, divorced, or widowed adults face longer hospital stays and higher readmissions rates than those who are married, as hospitals may require at-home caregivers for discharge (Adisa et al, 2018; Konda et al, 2020; Lu et al, 2016). Older adults living alone are less likely to die at home rather than in a nursing home or hospice facility than those living in larger households (Lei et al, 2021), suggesting that at-home help bolsters ability to live in community.…”