The Influence of Symptoms, Functional Status, and Social Vulnerability on Healthcare Use Among Patients Receiving Dialysis - PROJECT ABSTRACT 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, diminished functional status, and frequent emergency department (ED) visits and hospitalizations, which negatively affect their quality of life and contribute to a costly 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 in the context of the person’s social determinants of health (SDOH) remain understudied. This is a significant gap as most people on dialysis are from disadvantaged communities (e.g., racial minority and lower socioeconomic status) and are affected by multiple SDOH simultaneously. For these patients, understanding how social vulnerability of the community where they live influences the relationships among symptom severity, functional status, and healthcare use is crucial to improve health outcomes. 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 and examine the role of social vulnerability as a moderator and/or mediator of those relationships. The CDC’s Social Vulnerability Index (SVI) will be used as a collective measure of multiple SDOH. The original study (R01NR013359: PI Song) recruited from dialysis centers in 7 counties in North Carolina and examined the trajectories of multidimensional quality of life, including physical, emotional, and cognitive symptoms and functional status, and collected healthcare use data monthly for 12 months (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 whether symptom severity, functional status, and healthcare use vary by SVI levels of patients receiving dialysis at baseline, 6 months, and 12 months; and 3) examine whether differences in SVI influence the relationships among symptom severity, functional status, and healthcare use over time in patients receiving dialysis using multilevel modeling. This study aligns with the NINR’s priorities to tackle today’s health challenges by addressing the role of community-level SDOH in the relationships among symptom severity, functional status, and healthcare use of patients on dialysis. The findings of this study will help identify individuals whose healthcare use is most affected by symptoms and functional status and inform development of future screening tools and interventions to support these individuals. With guidance from my mentors, the proposed training plan will help me develop the necessary skills and expertise to complete the proposed study and become an independent nurse scientist leading research involving patients on dialysis.
