Title

Psychosocial predictors of hospital utilization in wait-list hemodialysis and transplant patients

Date of Award

1998

Availability

Article

Degree Name

Doctor of Philosophy (Ph.D.)

First Committee Member

Gail Ironson, Committee Chair

Second Committee Member

Andrew Brickman, Committee Member

Abstract

This study examined the influence of medical, demographic and psychosocial variables upon five inpatient hospital utilization outcome measures (total costs, total reimbursements, mean length of stay, total hospital days and total number of admissions) in a renal dialysis and transplant population. Utilization variables were analyzed over one and two year time periods, either post-evaluation for transplant candidacy (wait-list patients) or post-surgically. Overall, creatinine, unemployment, marital status, anger, coping responses (active and avoidance coping, and denial) and perceived family environment were predictive of greater inpatient utilization. Analyses of the one-year wait-list group outcomes revealed that separated/divorced/widowed status, diabetes comorbidity, depression, anger and active coping were significant predictors. Among the two-year outcomes for the wait-list group, younger age, normotensive status, peritoneal dialysis therapy, depression, anger, and active coping were predictors of utilization. Within the first year outcomes for the transplant recipients, receiving a living-related donor organ, hemodialysis treatment prior to transplantation, creatinine levels, being male, unemployment, anxiety, anger, family environments characterized by cohesion and conflict, active coping and denial were significant predictors of utilization. In the two year transplant group, unemployment, creatinine, depression, anger, family environments characterized by control or a moral/religious emphasis, and coping styles (active, seeking social support and avoidance coping) were all significant predictors of utilization. The findings reinforce the importance of psychosocial factors on inpatient hospital utilization among a renal disease population. These psychosocial factors may impact utilization directly and also indirectly through compliance behaviors and self-care. Additionally, while medical variables such as creatinine levels and type of renal replacement therapy administered are relatively fixed entities, psychosocial influences such as depression, anger, coping responses, family environments and social support are generally fluid, and thereby amenable to intervention.

Keywords

Health Sciences, Medicine and Surgery; Psychology, Clinical; Health Sciences, Health Care Management

Link to Full Text

http://access.library.miami.edu/login?url=http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:9824539