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Access Type

WSU Access

Date of Award

January 2017

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Mark A. Lumley

Abstract

Background: The U.S. Centers for Medicare and Medicaid Services have mandated reducing early hospital readmissions (i.e., within 30 days of discharge) to both improve patient care and reduce expenses. Patients with end-stage renal disease (ESRD) have relatively high early readmission rates, due in part to their complex medical regimens but also cognitive impairment, health literacy problems, and lack of social support. We developed a brief family consultation intervention to address these problems and tested its ability to reduce early readmissions among patients with ESRD.

Method: 120 hospitalized adults with ESRD (M age = 57.5 years; 50% male; 86% Black, 12% White) were recruited from an urban, inpatient nephrology unit. Patients were randomized to family consultation (FC; n = 60) or treatment-as-usual (TAU) control (n = 60) conditions. Family consultations, conducted either bedside or via telephone, were conducted with 57 of the 60 assigned patients and covered psychoeducation about cognitive and behavioral risk factors for readmission and how to compensate for them. Blinded medical record review was conducted later to determine readmissions within 30 days.

Results: Chi-square tests and logistic regressions tested intervention effects. Per protocol analyses (excluding three FC patients who received no consultation) indicated that FC reduced early readmission (18%) after discharge, compared to TAU (32%; χ = 3.13, p = .039), and reduced any early hospital return visit (emergency department, brief observation, or readmission) compared to TAU (28% vs. 47%; χ = 4.31, p = .019). Intent-to-treat analyses revealed that FC marginally reduced readmission (20%) compared to TAU (32%; χ = 2.13, p = .077), but FC still significantly reduced any hospital visit (32%) compared to TAU (47%; χ = 2.83, p = .046).

Discussion: A brief psychosocial intervention with family members can decrease readmissions in patients with ESRD, thereby improving health outcomes and reducing costs.

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