Hematopoietic Stem Cell Transplantation Recipient and Caregiver Factors Affecting Length of Stay and Readmission

Purpose/objectives: To evaluate the contributions of patient and caregiver factors to length of stay (LOS) and 30-day readmission status for recipients of allogeneic hematopoietic stem cell transplantation (HSCT).
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Design: Secondary data analysis from a phase 2 clinical trial.
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Setting: National Institutes of Health Clinical Center in Bethesda, Maryland.
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Sample: 68 dyads (N = 136) comprised of patients receiving HSCT and their caregivers. 
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Methods: Multiple linear regression and logistic regression analyses were used to investigate associations between caregiver and patient factors and outcomes.
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Main Research Variables: Patients' initial LOS, 30-day readmission, and demographic and disease characteristics; caregiver demographic factors, health problems, psychological distress, burden, and self-efficacy. 
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Findings: Twenty-five patients were readmitted within 30 days after hospital discharge following their initial hospitalization for HSCT. LOS was 34% longer for patients with infection than patients without infection. Patients with grade 2 or greater acute graft-versus-host disease (GVHD) stayed longer compared to patients with no or mild acute GVHD. Patients who had nonspousal caregivers stayed longer than patients with spousal caregivers. Infection was significantly related to readmission.
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Conclusions: Knowledge regarding factors associated with increased LOS and 30-day readmission can help nurses and transplantation team members anticipate the healthcare needs of patients receiving HSCT, improve outcomes, and decrease the use of expensive health services. 
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Implications For Nursing: Educating patients and caregivers on infection prevention is critically important to reduce LOS and 30-day readmission after HSCT.