The Influence of Symptoms, Functional Status, and Geographic Factors on Healthcare Use Among Patients Receiving Dialysis - For patients with end-stage renal disease, dialysis is a life-sustaining therapy unless they receive a kidney transplant. Over half a million patients receiving dialysis in the U.S. experience multiple ongoing symptoms, reduced functional status, and frequent emergency department (ED) visits and hospitalizations, which place a significant burden on the healthcare system. While previous research in this population has focused on clinical factors (e.g., fluid and electrolyte imbalances) as main causes of healthcare use, other factors, such as symptom severity and functional status, remain understudied. The proposed secondary analysis using a longitudinal dataset will examine the relationships among symptom severity, functional status, and healthcare use over time in patients receiving dialysis. The original study (R01NR013359: PI Song) recruited from dialysis centers in 7 counties in North Carolina and collected monthly data over 12 months on physical, emotional, and cognitive symptoms, functional status, and healthcare use (n=227; 13 data points). Guided by the Behavioral Model of Health Service Use and The Theory of Unpleasant Symptoms, the proposed study will 1) determine whether symptom severity and functional status influence healthcare use (measured by ED visits and hospital admissions) in patients receiving dialysis at baseline, 6 months, and 12 months; 2) examine variation in symptom severity, functional status, and healthcare use across geographic regions and objective clinical indicators at baseline, 6 months, and 12 months; and 3) examine longitudinal relationships between symptom severity, functional status, and healthcare use using multilevel statistical approaches, controlling for regional and clinical variation. The findings of this study will clarify the clinical pathways contributing to healthcare use in patients receiving dialysis and help to identify patients who exhibit patterns of high healthcare use related to symptoms and functional status. This research supports the development of future screening tools and interventions that support effective care planning and clinical decision-making. With guidance from my mentors, the proposed training plan will provide advanced instruction in longitudinal analysis, research design, and health services research to complete the proposed study and pursue a career in clinical outcomes research.
