TY - JOUR
T1 - Understanding patient-centred readmission factors
T2 - A multi-site, mixed-methods study
AU - Greysen, S. Ryan
AU - Harrison, James D.
AU - Kripalani, Sunil
AU - Vasilevskis, Eduard
AU - Robinson, Edmondo
AU - Metlay, Joshua
AU - Schnipper, Jeffery L.
AU - Meltzer, David
AU - Sehgal, Neil
AU - Ruhnke, Gregory W.
AU - Williams, Mark V.
AU - Auerbach, Andrew D.
N1 - Funding Information:
SRG is supported by the NIH, National Institute of Aging (NIA) through the Claude D. Pepper Older Americans Independence Center (P30AG021342 NIH/NIA), a Career Development Award (1K23AG045338-01) and the NIH-NIA Loan Repayment Program. ADA is supported by the National Heart Lung and Blood Institute through a K-24 Career Mentoring Award. The Association of American Medical Colleges provided start-up matching funds for the establishment of the Hospital Medicine Re-engineering Network (HOMERuN).
Publisher Copyright:
© 2017 Published by the BMJ Publishing Group Limited.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Importance Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients' perceptions of self-care and other factors related to readmission. Objectives To characterise patient-reported or caregiver-reported factors contributing to readmission. Design, setting and participants Cross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers. Measurements Multiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns. Results We interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%). Limitations The study population included only patients readmitted at academic medical centres and may not be representative of community-based care. Conclusion Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.
AB - Importance Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients' perceptions of self-care and other factors related to readmission. Objectives To characterise patient-reported or caregiver-reported factors contributing to readmission. Design, setting and participants Cross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers. Measurements Multiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns. Results We interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%). Limitations The study population included only patients readmitted at academic medical centres and may not be representative of community-based care. Conclusion Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.
KW - Health policy
KW - Health services research
KW - Hospital medicine
KW - Patient-centred care
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85011717328&partnerID=8YFLogxK
U2 - 10.1136/bmjqs-2015-004570
DO - 10.1136/bmjqs-2015-004570
M3 - Article
C2 - 26769841
AN - SCOPUS:85011717328
SN - 2044-5415
VL - 26
SP - 33
EP - 41
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 1
ER -