PowerPoint Slides for: Psychosocial Factors and 30-Day Hospital Readmission among Individuals Receiving Maintenance Dialysis: A Prospective Study

<b><i>Background:</i></b> Thirty-day hospital readmissions are common among maintenance dialysis patients. Prior studies have evaluated easily measurable readmission risk factors such as comorbid conditions, laboratory results, and hospital discharge day. We undertook this prospective study to investigate the associations between hospital-assessed depression, health literacy, social support, and self-rated health (separately) and 30-day hospital readmission among dialysis patients. <b><i>Methods:</i></b> Participants were recruited from the University of North Carolina Hospitals, 2014-2016. Validated depression, health literacy, social support, and self-rated health screening instruments were administered during index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to examine readmission risk factors. <b><i>Results:</i></b> Of the 154 participants, 58 (37.7%) had a 30-day hospital readmission. In unadjusted analyses, individuals with positive screening for depression, lower health literacy, and poorer social support were more likely to have a 30-day readmission (vs. negative screening). Positive depression screening and poorer social support remained significantly associated with 30-day readmission in models adjusted for race, heart failure, admitting service, weekend discharge day, and serum albumin: adjusted OR (95% CI) 2.33 (1.02-5.15) for positive depressive symptoms and 2.57 (1.10-5.91) for poorer social support. The area under the receiver operating characteristic curve (AUC) of the multivariable model adjusted for social support status was significantly greater than the AUC of the multivariable model without social support status (test for equality; <i>p</i> value = 0.04). <b><i>Conclusion:</i></b> Poor social support and depressive symptoms identified during hospitalizations may represent targetable readmission risk factors among dialysis patients. Our findings suggest that hospital-based assessments of select psychosocial factors may improve readmission risk prediction.

**背景：** 维持性透析患者的30天院内再入院情况十分常见。既往研究已对易于评估的再入院风险因素展开评估，例如合并症、实验室检测结果以及出院日等。本研究为前瞻性研究，旨在分别探讨住院评估的抑郁状态、健康素养、社会支持与自评健康状况与透析患者30天院内再入院之间的关联。
**方法：** 研究对象于2014年至2016年间从北卡罗来纳大学附属医院招募。在首次住院期间，研究者采用经过验证的抑郁、健康素养、社会支持及自评健康筛查工具开展评估。以30天再入院为因变量，构建多变量logistic回归模型，以分析再入院风险因素。
**结果：** 154名研究对象中，58人（37.7%）发生了30天院内再入院。单因素分析结果显示，抑郁筛查阳性、健康素养水平较低以及社会支持状况较差的患者，其30天再入院风险显著高于筛查阴性或状况较好的患者。在校正了种族、心力衰竭、收治科室、周末出院以及血清白蛋白水平等混杂因素后，抑郁筛查阳性与社会支持状况较差仍与30天再入院存在显著关联：抑郁症状阳性的校正比值比（OR，95%置信区间CI）为2.33（1.02~5.15），社会支持状况较差的校正OR为2.57（1.10~5.91）。纳入社会支持状况的多变量模型的受试者工作特征曲线下面积（AUC）显著高于未纳入社会支持状况的多变量模型（组间比较检验，P=0.04）。
**结论：** 住院期间筛查发现的社会支持不足与抑郁症状，可作为透析患者可干预的再入院风险因素。本研究结果提示，针对特定社会心理因素开展住院评估，或可提升再入院风险预测的准确性。