Quality of Life among Participants in a Patient-Centered Medical Home Intervention for Patients with End-stage Renal Disease on Hemodialysis

Porter AC, Fitzgibbon ML, Fischer M, Chukwudozie IB, Berbaum ML, Schiffer L, Hynes DM. Quality of Life among Participants in a Patient-Centered Medical Home Intervention for Patients with End-stage Renal Disease on Hemodialysis. Insights in Internal Medicine. 2017 Jun 16; 1(2):1-10.

Related HSR&D Project(s)

• RCS 98-352 – Research Career Scientist Award

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Abstract:

Purpose To describe baseline quality of life (QOL) among a racially and ethnically diverse cohort in a study of the implementation of a Patient-Centered Medical Home for Kidney Disease for patients with end-stage renal disease (ESRD) on hemodialysis, and to evaluate the associations of QOL and patient-reported outcomes and sociodemographic and clinical characteristics. Methods QOL was measured using the Kidney Disease Quality of Life-36 (KDQOL-36) at baseline, and sociodemographic and clinical data were collected, along with multiple patient-reported outcome measures: care coordination, health literacy, self-efficacy, hemodialysis knowledge, depression, medication compliance, patient satisfaction, and compliance with and attitudes toward dietary restrictions. Results Data were available for 171 participants. The majority were African-American (49%) or Hispanic (47%), and had household income below $20,000/year (68%). Older participants reported lower physical QOL than younger participants, and Hispanics reported lower burden scores compared to African-Americans. Participants with lower health literacy, lower self-efficacy scores, or depressive symptoms reported lower QOL scores. Conclusions Although QOL is known to be low in ESRD participants, this study identifies additional subgroups at risk for low QOL. Hispanic patients, those with low health literacy, low self-efficacy, and depression are at particular risk. Further study is needed to determine how to improve QOL in this population.