Evidence map›Paper›PMID 31906871›Full record

Observational studyBMC nephrology2020

Social determinants of health associated with hemodialysis non-adherence and emergency department utilization: a pilot observational study.

Kamna S Balhara, Lori Fisher, Naya El Hage, Rosemarie G Ramos, Bernard G Jaar

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC nephrology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
3.7field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Article
  6. Observational
  7. Article
  8. Patients' Perspectives on Health-Related Social Needs and Recommendations for Interventions: A Qualitative Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2024
    Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. A Scoping Review of Current Social Emergency Medicine Research.The western journal of emergency medicine · 2021
    Article
  14. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Kamna S BalharaThe Johns Hopkins University School of Medicine, Baltimore, MD, USA. kamna.balhara@gmail.com.ORCID 0000-0001-6302-3355
Lori FisherThe Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Naya El HageThe Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Rosemarie G RamosThe University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Bernard G JaarThe Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins University · USThe University of Texas Health Science Center at San Antonio · USUniversity of the West Indies System · JM

Funding

National Kidney Foundation Serving Maryland and Delaware Norma E. Clauss Clinical Research Award
6 · The paper itself

Abstract

backgroundDialysis patients who miss treatments are twice as likely to visit emergency departments (EDs) compared to adherent patients; however, prospective studies assessing ED use after missed treatments are limited. This interdisciplinary pilot study aimed to identify social determinants of health (SDOH) associated with missing hemodialysis (HD) and presenting to the ED, and describe resource utilization associated with such visits.

methodsWe conducted a prospective observational study with a convenience sample of patients presenting to the ED after missing HD (cases); patients at local dialysis centers identified as HD-compliant by their nephrologists served as matched controls. Patients were interviewed with validated instruments capturing associated risk factors, including SDOH. ED resource utilization by cases was determined by chart review. Chi-square tests and ANOVA were used to detect statistically significant group differences.

resultsAll cases visiting the ED had laboratory and radiographic studies; 40% needed physician-performed procedures. Mean ED length of stay (LOS) for cases was 17 h; 76% of patients were admitted with average LOS of 6 days. Comparing 25 cases and 24 controls, we found no difference in economic stability, educational attainment, health literacy, family support, or satisfaction with nephrology care. However, cases were more dependent on public transport for dialysis (p = 0.03). Despite comparable comorbidity burdens, cases were more likely to have impaired mobility, physical limitations, and higher severity of pain and depression. (p < 0.05).

conclusionsED visits after missed HD resulted in elevated LOS and admission rates. Frequently-cited SDOH such as health literacy did not confer significant risk for missing HD. However, pain, physical limitations, and depression were higher among cases. Community-specific collaborations between EDs and dialysis centers would be valuable in identifying risk factors specific to missed HD and ED use, to develop strategies to improve treatment adherence and reduce unnecessary ED utilization.

Indexed as

Patient ComplianceRenal DialysisSocial Determinants of HealthEmergency Service, HospitalFemaleHospitalizationHumansMaleMiddle AgedPatient Acceptance of Health CarePilot ProjectsProspective StudiesDialysisEmergency departmentNon-adherenceSocial determinants of health

Identifiers

PMID31906871
PMCPMC6943919
OpenAlexW2999923383

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.