Background
Methods
Study design and population
Study variables
Readmission
Psychosocial factors
Psychosocial factors | Question/item | Possible responses |
---|---|---|
Mental health domain | ||
History of substance abuse | Has the patient ever had a history of substance abuse? | • No • Yes |
Depression or anxiety | Are there signs/symptoms present for depression or anxiety problems? | • No • Yes |
Social support domain | ||
Relationship status | What is the patient’s relationship status? | • Domestic partner • Married • Divorced • Single • Widowed • Separated |
Living alone | With whom does the patient live? | • Lives alone • Lives with parents • Spouse • Children • Significant other • Friend • Relative • Other |
Frequency of social support | What is the level of involvement of family and friend on a regular basis? | • Daily • Weekly • Monthly • Less frequently than monthly |
Independence domain | ||
Impaired memory | Does the patient appear to have a problem with the following? | Short term memory • No • Yes Long term memory • No • Yes |
Current employment | Current employment? | • Employed full-time • Employed part-time • Retired • Medical leave of absence • Unemployed-by choice • Unemployed disabled • Unemployed-looking for work • Other |
Mobility impairment | Ambulatory assistance? | • None • Cane/crutch • Walker or • Manual wheelchair • Electric wheelchair • Limb prosthesis |
Type of housing | Living status? | • Home • Condo • Mobile home • Apartment • Rents house • Assisted living • Homeless • Public housing shelter • Long term care facility(SNF) • Acute rehabilitation center • Correctional facility • Adult family home • Adult group home |
Ease of adherence domain | ||
Coming to dialysis | Over the past month, how easy or difficult has it been for you to come to each hemodialysis treatment? | • N/A • Very easy • Somewhat easy • Neither easy nor difficult • Somewhat difficult • Very difficult |
Completing dialysis sessions | Over the past month, how easy or difficult has it been for you to complete the full-prescribed hemodialysis treatment time? | • N/A • Very easy • Somewhat easy • Neither easy nor difficult • Somewhat difficult • Very difficult |
Taking medications | Over the past month, how easy or difficult has it been for you to take medications as prescribed? | • N/A • Very easy • Somewhat easy • Neither easy nor difficult • Somewhat difficult • Very difficult |
Adhering to dietary restrictions | Over the past month, how easy or difficult has it been for you to follow dietary restrictions? | • N/A • Very easy • Somewhat easy • Neither easy nor difficult • Somewhat difficult • Very difficult |
Adhering to fluid restrictions | Over the past month, how easy or difficult has it been for you to follow fluid restrictions? | • N/A • Very easy • Somewhat easy • Neither easy nor difficult • Somewhat difficult • Very difficult |
Other variables
Statistical analysis
Results
Patient characteristics
Characteristic |
N
| Overall | Readmitted (n = 159) | Not readmitted (n = 560) |
P*
|
---|---|---|---|---|---|
Patient characteristics | |||||
Mean age (SD), years |
719
| 56.1 (14.9) | 55.2 (15.4) | 56.3 (14.7) |
0.4
|
Male sex, n (%) |
719
| 378 (52.6) | 78 (49.1) | 300 (53.6) |
0.3
|
Black race, n (%) |
718
| 659 (91.8) | 147 (92.5) | 512 (91.6) |
> 0.9
|
Medical insurance at dialysis start, n (%) |
692
|
0.5
| |||
Medicare | 122 (17.6) | 34 (22.2) | 88 (16.3) | ||
Medicaid | 165 (23.8) | 36 (23.5) | 129 (23.9) | ||
Private | 170 (24.6) | 34 (22.2) | 136 (25.2) | ||
Other | 63 (9.1) | 14 (9.2) | 49 (9.1) | ||
None | 172 (24.9) | 35 (22.9) | 137 (25.4) | ||
Comorbid conditions, n (%) |
719
| ||||
Congestive heart failure | 244 (33.4) | 64 (40.3) | 180 (32.1) |
0.06
| |
Hypertension | 701 (97.5) | 155 (97.5) | 546 (97.5) |
> 0.9
| |
Diabetes | 349 (48.5) | 79 (49.7) | 270 (48.2) |
0.7
| |
Atherosclerotic cardiovascular disease | 141 (19.6) | 34 (21.4) | 107 (19.1) |
0.5
| |
Cause of ESRD, n (%) |
712
|
0.3
| |||
Hypertension | 308 (43.3) | 49 (30.8) | 144 (26.0) | ||
Diabetes | 193 (27.1) | 69 (43.4) | 239 (43.2) | ||
Glomerulonephritis | 73 (10.3) | 18 (11.3) | 55 (10.0) | ||
Other | 138 (19.4) | 23 (14.5) | 115 (20.8) | ||
Median duration of ESRD (IQR), years |
719
| 2.1 (0.6–5.9) | 1.5 (0.5–5.4) | 2.2 (0.7–6.3) |
0.1
|
Index admission characteristics | |||||
Median length of stay (IQR), days |
719
| 4 (2–6) | 4 (2–8) | 3 (2–6) |
0.007
|
Intensive care utilization, n (%) |
719
| 156 (21.7) | 42 (26.4) | 114 (20.4) |
0.1
|
Distributions of psychosocial factors
Psychosocial domain/factor |
N
| n (%) |
P*
| ||
---|---|---|---|---|---|
Overall | Readmitted | Not readmitted | |||
Mental health | |||||
History of substance abuse, yes vs. no |
680
| 90 (13.2) | 22 (15.0) | 68 (12.8) |
0.3
|
Depression or anxiety, yes vs.no |
666
| 114 (17.1) | 21 (14.5) | 93 (17.9) |
0.5
|
Social support | |||||
Marital Status |
686
|
0.3
| |||
Never married | 239 (34.8) | 40 (26.5) | 173 (32.3) | ||
Married/ domestic partner | 213 (31.1) | 59 (39.1) | 180 (33.6) | ||
Divorced/separated/widowed | 234 (34.1) | 52 (34.4) | 182 (34.0) | ||
Living alone |
688
| 150 (21.8) | 34 (22.7) | 116 (21.6) |
0.8
|
Daily social support |
673
| 469 (69.7) | 100 (67.6) | 369 (70.3) |
0.5
|
Independence | |||||
Impaired memory |
678
| 106 (15.6) | 19 (13.1) | 87 (16.3) |
0.3
|
Employment at assessment |
542
|
0.4
| |||
Employed | 43 (7.9) | ---** | 37 (8.7) | ||
Disabled | 314 (57.9) | 67 (57.8) | 247 (58.0) | ||
Unemployed | 185 (34.1) | 43 (37.1) | 142 (33.3) | ||
Community-dwelling |
678
| 623 (91.9) | 135 (91.2) | 488 (92.1) |
0.7
|
Requires ambulatory assistance |
683
| 278 (40.7) | 55 (37.4) | 223 (41.6) |
0.4
|
Ease of adherence | |||||
Easy to come to dialysis |
517
| 397 (76.8) | 92 (80.7) | 305 (75.7) |
0.3
|
Easy to complete dialysis |
513
| 387 (75.4) | 85 (75.9) | 302 (75.3) |
0.9
|
Easy to take medications |
527
| 441 (83.7) | 98 (83.1) | 343 (83.9) |
0.8
|
Easy to adhere to dietary restrictions |
523
| 332 (63.5) | 69 (60.0) | 263 (64.5) |
0.3
|
Easy to adhere to fluid restrictions |
519
| 358 (69.0) | 75 (65.2) | 283 (70.1) |
0.3
|
Association of Psychosocial Factors with 30-day readmissions
Psychosocial domain/factor | No. (%) readmitted within 30 days | OR (95% CI) for readmission | |
---|---|---|---|
Unadjusted | Adjusted* | ||
Mental health | |||
History of substance abuse | |||
Overall | 147/680 (21.6%) | – | – |
No | 125/590 (21.2%) | 1.00 (referent) | 1.00 (referent) |
Yes | 22/90 (24.4%) | 1.20 (0.72–2.02) | 1.29 (0.75–2.23) |
Depression or anxiety | |||
Overall | 145/666 (21.8%) | – | – |
No | 124/552 (22.5%) | 1.00 (referent) | 1.00 (referent) |
Yes | 21/114 (18.4%) | 0.78 (0.47–1.30) | 0.80 (0.47–1.36) |
Social support | |||
Marital status | |||
Overall | 151/686 (22.0%) | – | – |
Married/domestic partner | 40/213 (18.8%) | 1.00 (referent) | 1.00 (referent) |
Never married | 59/239 (24.7%) | 1.42 (0.90–2.23) | 1.38 (0.84–2.27) |
Widowed/divorced/separated | 52/234 (22.2%) | 1.24 (0.79–1.96) | 1.17 (0.73–1.90) |
Lives alone | |||
Overall | 150/688 (21.8%) | – | – |
No | 116/538 (21.6%) | 1.00 (referent) | 1.00 (referent) |
Yes | 34/150 (22.7%) | 1.07 (0.69–1.65) | 1.16 (0.74–1.81) |
Frequency of social support | |||
Overall | 148/673 (22.0%) | – | – |
Daily | 100/469 (21.3%) | 1.00 (referent) | 1.00 (referent) |
Not daily | 48/204 (23.5%) | 1.14 (0.77–1.68) | 1.14 (0.76–1.70) |
Independence | |||
Impaired memory | |||
Overall | 145/678 (21.4%) | – | – |
No | 126/572 (22.0%) | 1.00 (referent) | 1.00 (referent) |
Yes | 19/106 (17.9%) | 0.77 (0.45–1.32) | 0.76 (0.44–1.32) |
Employment status | |||
Overall | 116/542 (21.4%) | – | – |
Unemployed | 43/185 (23.2%) | 1.00 (referent) | 1.00 (referent) |
Disabled | 67/314 (21.3%) | 0.90 (0.58–1.38) | 0.80 (0.49–1.32) |
Employed | 6/43 (14.0%) | 0.54 (0.21–1.35) | 0.54 (0.20–1.45) |
Type of Housing | |||
Overall | 148/678 (21.8%) | – | – |
Community-dwelling | 135/623 (21.7%) | 1.00 (referent) | 1.00 (referent) |
Assisted living/nursing home | 13/55 (23.6%) | 1.12 (0.58–2.14) | 1.07 (0.52–2.17) |
Ambulatory assistance | |||
Overall | 147/683 (21.8%) | – | – |
No | 92/405 (22.7%) | 1.00 (referent) | 1.00 (referent) |
Yes | 55/278 (19.8%) | 0.84 (0.58–1.22) | 0.75 (0.48–1.16) |
Ease of adherence | |||
Coming to dialysis | |||
Overall | 114/517 (22.1%) | – | – |
Easy | 92/397 (23.2%) | 1.00 (referent) | 1.00 (referent) |
Difficult | 22/120 (18.3%) | 0.74 (0.44–1.25) | 0.75 (0.44–1.27) |
Completing dialysis | |||
Overall | 112/513 (21.8%) | – | – |
Easy | 85/387 (22.0%) | 1.00 (referent) | 1.00 (referent) |
Difficult | 27/126 (21.4%) | 0.97 (0.59–1.58) | 0.98 (0.59–1.62) |
Taking medications | |||
Overall | 118/527 (22.4%) | – | – |
Easy | 98/441 (22.2%) | 1.00 (referent) | 1.00 (referent) |
Difficult | 20/86 (23.3%) | 1.06 (0.61–1.84) | 1.04 (0.59–1.82) |
Adhering to diet restrictions | |||
Overall | 115/523 (22.0%) | – | – |
Easy | 69/332 (20.8%) | 1.00 (referent) | 1.00 (referent) |
Difficult | 46/191 (24.1%) | 1.21 (0.79–1.85) | 1.20 (0.78–1.85) |
Adhering to fluid restrictions | |||
Overall | 115/519 (22.2%) | – | – |
Easy | 75/358 (21.0%) | 1.00 (referent) | 1.00 (referent) |
Difficult | 40/161 (24.8%) | 1.25 (0.80–1.93) | 1.22 (0.78–1.92) |
Psychosocial domain/factor | Unadjusted OR (95% CI) | |
---|---|---|
Pulmonary edema-related readmission vs. no readmission | Other readmission vs. no readmission | |
Mental health | ||
History of substance abuse | ||
No | 1.00 (referent) | 1.00 (referent) |
Yes | 1.00 (0.41–2.45) | 1.30 (0.72–2.35) |
Depression or anxiety | ||
No | 1.00 (referent) | 1.00 (referent) |
Yes | 0.67 (0.28–1.63) | 0.83 (0.46–1.51) |
Social support | ||
Marital status | ||
Married/domestic partner | 1.00 (referent) | 1.00 (referent) |
Never married | 1.36 (0.63–2.93) | 1.44 (0.86–2.43) |
Widowed/divorced/separated | 1.35 (0.62–2.90) | 1.19 (0.69–2.04) |
Lives alone | ||
No | 1.00 (referent) | 1.00 (referent) |
Yes | 0.65 (0.28–1.50) | 1.28 (0.79–2.07) |
Frequency of social support | ||
Overall | – | – |
Daily | 1.00 (referent) | 1.00 (referent) |
Not daily | 1.11 (0.58–2.11) | 1.15 (0.73–1.81) |
Independence | ||
Impaired memory | ||
No | 1.00 (referent) | 1.00 (referent) |
Yes | 1.05 (0.48–2.33) | 0.65 (0.33–1.26) |
Employment status | ||
Overall | – | – |
Unemployed | 1.00 (referent) | 1.00 (referent) |
Disabled | 0.27 (0.03–2.15) | 0.66 (0.24–1.83) |
Employed | 0.90 (0.45–1.82) | 0.89 (0.54–1.49) |
Type of Housing | ||
Community-dwelling | 1.00 (referent) | 1.00 (referent) |
Assisted living/nursing home | 2.45 (1.07–5.58) | 0.60 (0.23–1.55) |
Ambulatory assistance | ||
No | 1.00 (referent) | 1.00 (referent) |
Yes | 1.23 (0.67–2.26) | 0.70 (0.45–1.10) |
Ease of adherence | ||
Coming to dialysis | ||
Easy | 1.00 (referent) | 1.00 (referent) |
Difficult | 1.00 (0.46–2.19) | 0.63 (0.33–1.20) |
Completing dialysis | ||
Easy | 1.00 (referent) | 1.00 (referent) |
Difficult | 1.34 (0.64–2.83) | 0.81 (0.45–1.48) |
Taking medications | ||
Easy | 1.00 (referent) | 1.00 (referent) |
Difficult | 1.17 (0.50–2.78) | 1.01 (0.53–1.93) |
Adhering to diet restrictions | ||
Easy | 1.00 (referent) | 1.00 (referent) |
Difficult | 1.30 (0.65–2.59) | 1.17 (0.71–1.92) |
Adhering to fluid restrictions | ||
Easy | 1.00 (referent) | 1.00 (referent) |
Difficult | 1.67 (0.83–3.35) | 1.08 (0.64–1.82) |