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Understanding patient-centred readmission factors: a multi-site, mixed-methods study
  1. S Ryan Greysen1,
  2. James D Harrison1,
  3. Sunil Kripalani2,
  4. Eduard Vasilevskis2,
  5. Edmondo Robinson3,
  6. Joshua Metlay4,
  7. Jeffery L Schnipper5,
  8. David Meltzer6,
  9. Neil Sehgal7,
  10. Gregory W Ruhnke6,
  11. Mark V Williams8,
  12. Andrew D Auerbach1
  1. 1Division of Hospital Medicine, University of California, San Francisco, CA, USA
  2. 2Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA
  3. 3Christiana Heath Care System, Wilmington, DE, USA
  4. 4Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
  5. 5Division of General Internal Medicine, Brigham and Womens Hospital, Boston, MA, USA
  6. 6Section of Hospital Medicine, University of Chicago, IL, USA
  7. 7School of Public Health, University of California, Berkeley, CA, USA
  8. 8Division of Hospital Medicine, University of Kentucky, Louisville, KY, USA
  1. Correspondence to Dr S Ryan Greysen, Division of Hospital Medicine, UCSF, 533 Parnassus Ave, UC Hall, Suite 127A, San Francisco, California 94143, USA; ryan.greysen{at}ucsf.edu

Abstract

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.

  • Health policy
  • Health services research
  • Hospital medicine
  • Patient-centred care
  • Qualitative research

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