Matthew J. Jasinski|Mark A. Lumley|Sandeep Soman|Jerry Yee|Mark W. Ketterer
Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease
Wayne State University|Wayne State University|Pediatric Nephrology of Alabama|Pediatric Nephrology of Alabama|Henry Ford Health System|Henry Ford Hospital
us centers medicare medicaid services mandated reducing early 30day hospital readmissions improve patient care reduce costs patients eskd elevated early readmission rates due part complex medical regimens also cognitive impairment literacy difficulties low social support mood problems developed brief family consultation intervention address risk factors tested whether would reduce early readmissionsone hundred twenty hospitalized adults eskd mean age58 years 50 men 86 black 14 white recruited urban inpatient nephrology unit patients randomized family consultation n60 treatmentasusual control n60 condition family consultations conducted discharge bedside via telephone educated family patients cognitive behavioral risk factors readmission particularly cognitive impairment compensate blinded medical record reviews conducted 30 days later determine readmission status primary outcome hospital return visit readmission emergency department observation secondary outcome logistic regressions tested effects consultation versus control outcomesprimary analyses intenttotreat risk 30day readmission family consultation n12 20 054 compared treatmentasusual controls n19 32 although effect statistically significant odds ratio 054 95 confidence interval 023 124 p015 similar magnitude nonsignificant result observed 30day hospital return visit family consultation n19 32 versus controls n28 47 odds ratio 053 95 confidence interval 025 11 p009 per protocol analyses excluding three patients receive assigned consultation revealed similar resultsa brief consultation family members patients cognitive psychosocial risk factors significant effect 30day hospital readmission patients eskd