Psychosocial predictors of outpatient utilization in kidney transplant recipients and wait-listed dialysis patients

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)

First Committee Member

Philip M. McCabe - Committee Chair

Second Committee Member

Robert O. Morgan - Committee Member


Medical, demographic, and psychosocial predictors of outpatient health care cost and service volume were examined in a Medicare enrolled sample of wait-listed hemodialysis patients and kidney-transplanted ESRD patients. Psychosocial and medical data from a pre-transplant evaluation at Jackson Memorial Hospital in Miami, FL was merged with data on outpatient physician services obtained from the Center for Medicare and Medicaid Services. Although it was hypothesized that the demographic and psychosocial factors were predicting over-utilization, the results strongly support that outpatient health care utilization is a multifaceted construct, at times reflecting positive health behaviors while suggesting maladaptive health behaviors at other times. Findings from this study indicate that primarily maladaptive demographic and psychosocial characteristics are associated with decreased outpatient utilization in wait-listed dialysis, while the demographic and psychosocial characteristics associated with decreased outpatient utilization in transplanted patients are mostly 'positive'. Outcome in dialysis patients appears to relate to compliance with the dialysis regimen and is predicted by variables including employment status, intelligence, and the amount of conflict and independence in families. Outcome in transplanted patients appears to be more complex, reflecting non-compliant behavior as much as complaint behavior. Predictors of outpatient utilization in transplanted patients include age, employment status, intelligence, agreeableness, conscientiousness, and coping styles. These findings stress the fact that how adaptive and maladaptive health care behaviors are reflected in utilization measures depends upon the specific situations under study and upon the 'optimal' level of use. Tailoring interventions to maximize 'adaptive' health care utilization while minimizing 'maladaptive' utilization may lead to improved outcome and fewer health complications. Additional research is needed to better define measures that represent under-utilization, appropriate utilization, and over-utilization.


Psychology, Behavioral; Economics, Finance; Health Sciences, Health Care Management

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