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The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study
  1. Jocelyn Carter1,
  2. Charlotte Ward2,3,
  3. Deborah Wexler4,
  4. Karen Donelan1,5
  1. 1Department of Medicine, Massachussetts General Hospital, Boston, Massachusetts, USA
  2. 2Center for Healthcare Studies, Northwestern University, Bridgeview, Illinois, USA
  3. 3Center for Health Statistics, University of Chicago, Chicago, Illinois, USA
  4. 4Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Mongan Institute for Health Policy Centre, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr. Jocelyn Carter, Department of Medicine, Massachussetts General Hospital, 50 Staniford Street, Suite 503A, Boston 02114, MA, USA; jcarter0{at}partners.org

Abstract

Objective Hospital readmissions comprise nearly a third of US healthcare expenditures. Fifteen to 20 per cent of this spending is considered to be potentially preventable. Risk prediction models have suboptimal accuracy and typically exclude patient experience data. No studies have explored patient perceptions of the likelihood of readmission during index admission. Our objective was to examine associations between patient perceptions of care during index hospital admission and 30-day readmission.

Design Prospective cohort study.

Setting Two inpatient adult medicine units at Massachusetts General Hospital, Boston, Massachusetts.

Participants Eight hundred and forty-six patients admitted to study units between January 2012 and January 2016 who met eligibility criteria and consented to enrolment.

Main outcome Odds of 30-day readmission.

Results Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) were readmitted within 30 days. Readmitted participants were less likely to have a high school diploma/GED (44.3% not readmitted vs 53.5% readmitted, P=0.02). In multivariable models adjusting for baseline differences, respondents who reported being ‘very satisfied’ with the care received during the index hospitalisation were less likely to be readmitted (adjusted OR 0.61, 95% CI 0.43 to 0.88, P=0.007). Participants reporting doctors ‘always listened to them carefully’ were less likely to be readmitted (adjusted OR 0.68, 95% CI 0.48 to 0.97, P=0.03). Participants reporting they were ‘very likely’ to be readmitted were not more likely to be readmitted (adjusted OR 1.35, 95% CI 0.83 to 2.19, P=0.22).

Conclusion Participants reporting high satisfaction and good provider communication were less likely to be readmitted. Rates of readmission were increased among participants stating they were very likely to be readmitted though this association was not statistically significant. Incorporating patient-reported measures during index hospitalisations may improve readmission prediction.

  • patient satisfaction
  • patient-centred care
  • hospital medicine
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Footnotes

  • Handling editor Kaveh G Shojania

  • Contributors JAC, DW and KD designed the study and outcomes of interest. JAC wrote the original manuscript. DW, KD and CW edited the manuscript. CW performed all statistical analysis.

  • Funding 2012 Clinician Teacher Development Award, MGPO, Massachusetts General Hospital

  • Competing interests DW reports serving as a consultant to Novartis on the management of hyperglycaemia associated with a novel oncology drug in May 2016.

  • Ethics approval The institutional review board at the Partners Human Research Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised full data set and statistical codes are available upon request.

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