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Abstract: TH-OR41

The Relationship Between Patient Activation and Clinical Outcomes: A Longitudinal, Retrospective, Observational Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Gopal, Tejas, Stanford University School of Medicine, Palo Alto, California, United States
  • Chen, Shijie, Satellite Healthcare, San Jose, California, United States
  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
Background

Patient activation, defined as an individual’s readiness, willingness, and ability to manage their own health and health care, is associated with healthy behaviors and improved outcomes. Patients undergoing in-center hemodialysis (HD) have low activation, but the association of patient activation with clinical outcomes among dialysis patients is unclear. We investigated the association between patient activation and outcomes in HD patients.

Methods

This cohort included 925 prevalent, in-center HD patients among 10 facilities in a mid-sized dialysis provider. Patients had completed a PAM-13 survey—a measure of patient activation—during a previous study. Patients were followed for 180 days after completion of the survey for the co-primary outcomes of (1) death and (2) the composite of death or hospitalization. Markers of non-adherence were examined as secondary outcomes, including (1) serum potassium >5.0 mEq/L; (2) serum phosphorus >5.5 mg/dL; (3) missed dialysis treatment due to absence (not hospitalization); and (4) interdialytic weight gain >4.0%. Univariate and adjusted regression models were fit to estimate associations of a 3-point increment in PAM-13 score with the outcomes of interest; adjustment factors comprised age, sex, dialysis vintage, serum albumin, and hospitalization history.

Results

A 3-point increment in PAM score was associated with lower hazard of death (univariate HR=0.89, 95% CI: 0.84 – 0.94; adjusted HR=0.91, 95% CI: 0.86-0.96), but not with the composite outcome of death or hospitalization (univariate HR=0.98, 95% CI: 0.96 – 1.00; adjusted HR=0.99, 95% CI: 0.96–1.00). There were no significant relationships between a 3-point increment in PAM score and any of the secondary outcomes in univariate and adjusted analyses.

Conclusion

In a cohort of prevalent, in-center HD patients, low activation was associated with mortality but not with hospitalization or measures of non-adherence.

Funding

  • Private Foundation Support