Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients.
Elder P, McGinty HL, Benson D, Huang Y, Devine S, Andritsos L, Vasu S, Richardson DR, Jaglowski S, Hofmeister C, Kirkendall C, Newlin J, Efebera Y, William B, Rosko AE, Penza S, Blum W, Klisovic R
Bone Marrow Transplant in press 02/14/2018
Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS?=?26.5, 52%) vs. at-risk (TERS?>?26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS?=?27-35.5, 39%) and moderate risk (TERS?>?35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR?=?1.62, p?=?0.02; moderate risk HR?=?2.50, p?=?0.002). Prior psychiatric history (HR?=?1.81, p?=?0.002) and poor coping skills (HR?=?1.64, p?=?0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk?=?12% vs. at-risk?=?25%, p?=?0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.