#4199 PSYCHOSOCIAL ASSESSMENTS AND HOSPITAL ADMISSION RATES IN ELEVATED OR HIGH ACUITY HEMODIALYSIS PATIENTS
Authors: Willetts Joanna , Chaudhuri Sheetal , Usvayt Len , Belmonte Kathleen , Speed Felicia , Rutherford Anna , Hymes Jeffrey 
Published: June 2023

Abstract

Background and Aims
Using data routinely captured in electronic medical records of a large dialysis organization (LDO) in close collaboration with social workers (MSW), we developed a weekly patient acuity score to identify the level of need for psychosocial support in hemodialysis patients to help social workers optimize visits to deliver timely personalized care. We evaluated how interventions by a MSW affected future hospital admission rate in in-center hemodialysis (ICHD) patients with Elevated or High acuity in an LDO.

Method
Using data from prevalent (vintage &gt;90 days) ICHD patients from Mar-2022 through Dec-2022, a weekly acuity score was computed using 95 routinely captured variables considered critical (e.g., psychosocial, cognitive, clinical, treatment, hospitalization). Each variable was assigned points based on a priori criteria which were summed and categorized based on population distribution for each week. Patient acuity was assigned as Low, Moderate, Elevated, or High based upon percentile distribution. We defined MSW interventions as the number of assessments completed (0, &lt;1, 1, or &gt;1 per month) during the baseline period (BL, Mar-2022 through May 2022). Next, we compared hospital admission rate in the BL period to that in a follow-up period (FU, June 2022 through Dec 2022) for patients whose acuity at start of BL was Elevated or High (E/H), stratified by monthly MSW assessment exposure. This analysis focuses on prevalent ICHD patients in the Elevated and High acuity categories at baseline (BL, March 2022 through May 2022) as they were expected to have been prioritized for MSW assessment.

Results
We identified 29,665 prevalent ICHD patients whose acuity was E/H at the start of BL; 8.2%, 24.8%, 20.9%, and 46.2% had 0, &lt;1, 1, and &gt;1 MSW assessments per month during BL, respectively. As expected, hospital admission rate was generally high for patients with E/H acuity. Likewise, for patients with E/H acuity, hospital admission rate increases as the number of monthly interventions in BL increases (Figure 1). For patients with E/H acuity, in each category of BL MSW assessment exposure, the hospital admission rate in FU is lower than in the BL period and the magnitude of the decrease is larger when there are more MSW assessments in the BL period; for 0, &lt;1, 1, and &gt;1 respective MSW assessments, the respective rate ratios were 0.99, 0.99, 0.98, and 0.90, and rate ratio was significantly lower for patients with &gt;1 MSW assessment in BL.

Conclusion
Our results suggest that acuity is helping MSW to identify patients with requiring more psychosocial and other needs as 46.2% of patients with E/H acuity had &gt;1 MSW assessment. Our results also suggest that &gt;1 MSW assessments in E/H acuity patients results in a larger magnitude in the decrease of hospital admission rates compared to other levels of MSW assessment exposure. Future analyses are needed to confirm these results.