Effect of Peer Mentorship on Hospitalizations among Patients Receiving Maintenance Hemodialysis: A Pragmatic Randomized Controlled Trial.

Abstract

BACKGROUND Patients receiving maintenance hemodialysis are hospitalized frequently, leading to disproportionate cost of care, and contributing to high morbidity and mortality. METHODS To test the effectiveness of peer mentorship to reduce hospitalization rates among patients receiving hemodialysis we performed a multi-center, pragmatic, randomized, controlled trial. Two hundred patient participants receiving hemodialysis at high risk for hospitalization were enrolled, 140 in Bronx, NY and 60 in Nashville, TN. Of these, 101 were randomized to the peer-mentor intervention and 99 were randomized to usual care. The intervention consisted of trained mentors, patients receiving hemodialysis, placing weekly telephone calls to their assigned patient participant mentees over a 3-month period. During telephone calls, mentors listened, provided emotional and informational support, and promoted self-management. During the intervention period and up to 15 months later, patient participants were observed for incidence of the primary outcome: monthly counts of unplanned hospitalizations and emergency department (ED) visits. RESULTS The mean age of all patient participants was 54 (SD 13) years, 100 (50%) were female, 110 (57%) were Black and 70 (39%) were Hispanic. The adjusted incidence rate ratio (aIRR) of primary outcome was not different between intervention vs. usual care in intention to treat analysis (aIRR 0.85; 95% CI 0.64,1.15). Pre-specified as treated analyses, with as treated defined by >20 minutes of telephone contact between mentor/mentee pairs, suggested effectiveness of peer mentoring (aIRR 0.60; 95% CI 0.47,0.76), and exploratory post-hoc analyses demonstrated differences in effectiveness by site and self-identified race of mentees. CONCLUSIONS Peer mentorship did not significantly reduce the rate of hospitalization or ED visits overall, but there may have been effectiveness among the following subgroups: those enrolled in Bronx, NY and those who self-identified as Black.