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Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial.
Clin J Am Soc Nephrol. 2018 06 07; 13(6):850-857.CJ

Abstract

BACKGROUND AND OBJECTIVES

The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

One hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient's cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes.

RESULTS

Primary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results.

CONCLUSIONS

A brief consultation with family members about the patient's cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD.

Authors+Show Affiliations

Department of Psychology, Wayne State University, Detroit, Michigan; and Departments of matthew.jasinski@wayne.edu.Department of Psychology, Wayne State University, Detroit, Michigan; and Departments of.Nephrology and.Nephrology and.Psychiatry, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29636355

Citation

Jasinski, Matthew J., et al. "Family Consultation to Reduce Early Hospital Readmissions Among Patients With End Stage Kidney Disease: a Randomized Controlled Trial." Clinical Journal of the American Society of Nephrology : CJASN, vol. 13, no. 6, 2018, pp. 850-857.
Jasinski MJ, Lumley MA, Soman S, et al. Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial. Clin J Am Soc Nephrol. 2018;13(6):850-857.
Jasinski, M. J., Lumley, M. A., Soman, S., Yee, J., & Ketterer, M. W. (2018). Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial. Clinical Journal of the American Society of Nephrology : CJASN, 13(6), 850-857. https://doi.org/10.2215/CJN.08450817
Jasinski MJ, et al. Family Consultation to Reduce Early Hospital Readmissions Among Patients With End Stage Kidney Disease: a Randomized Controlled Trial. Clin J Am Soc Nephrol. 2018 06 7;13(6):850-857. PubMed PMID: 29636355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial. AU - Jasinski,Matthew J, AU - Lumley,Mark A, AU - Soman,Sandeep, AU - Yee,Jerry, AU - Ketterer,Mark W, Y1 - 2018/04/10/ PY - 2017/08/06/received PY - 2018/03/22/accepted PY - 2018/4/11/pubmed PY - 2019/11/14/medline PY - 2018/4/12/entrez KW - Adult KW - Centers for Medicare and Medicaid Services (US) KW - Cognition KW - Cognitive Dysfunction KW - Emergency Service, Hospital KW - Humans KW - Inpatients KW - Kidney Failure, Chronic KW - Literacy KW - Logistic Models KW - Male KW - Medicaid KW - Medical Records KW - Medicare KW - Middle Aged KW - Patient Discharge KW - Patient Readmission KW - Referral and Consultation KW - Social Support KW - Telephone KW - United States KW - chronic kidney failure KW - nephrology KW - risk factors SP - 850 EP - 857 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 13 IS - 6 N2 - BACKGROUND AND OBJECTIVES: The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: One hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient's cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes. RESULTS: Primary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results. CONCLUSIONS: A brief consultation with family members about the patient's cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/29636355/Family_Consultation_to_Reduce_Early_Hospital_Readmissions_among_Patients_with_End_Stage_Kidney_Disease:_A_Randomized_Controlled_Trial_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=29636355 DB - PRIME DP - Unbound Medicine ER -