Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Abstract

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.

Figure 1

Cumulative incidence of hospital readmission with death as a competing risk illustrating the association between psychosocial risk as measured by the TERS and readmission in (a) all patients, (b) patients receiving an autologous HCT, and (c) patients receiving an allogeneic HCT. In analyzing all patients together, there is significant separation between the three groups with respect to incidence of readmission. For patients receiving an autologous HCT, there is a significant difference between the moderate risk patients and the other two groups. For patients receiving an allogeneic HCT, there is a significant difference between no-risk patients and the other two groups.