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Association between cultural factors and readmissions: the mediating effect of hospital discharge practices and care-transition preparedness
  1. Nosaiba Rayan-Gharra1,
  2. Ran D. Balicer2,
  3. Boaz Tadmor3,
  4. Efrat Shadmi1
  1. 1 The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
  2. 2 Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
  3. 3 The Rabin Medical Center Research Authority, Clalit Health Services, Petah Tikva, Israel
  1. Correspondence to Nosaiba Rayan-Gharra, The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel; nrayan84{at}


Objectives The study examines whether hospital discharge practices and care-transition preparedness mediate the association between patients’ cultural factors and readmissions.

Methods A prospective study of internal medicine patients (n=599) examining a culturally diverse cohort, at a tertiary medical centre in Israel. The in-hospital baseline questionnaire included sociodemographic, cultural factors (Multidimensional Health Locus of Control, family collectivism, health literacy and minority status) and physical, mental and functional health status. A follow-up telephone survey assessed hospital discharge practices: use of the teach-back method, providers’ cultural competence, at-discharge language concordance and caregiver presence and care-transition preparedness using the care transition measure (CTM). Clinical and administrative data, including 30-day readmissions to any hospital, were retrieved from the healthcare organisation’s data warehouse. Multiple mediation was tested using Hayes’s PROCESS procedure, model 80.

Results A total of 101 patients (17%) were readmitted within 30 days. Multiple logistic regressions indicated that all cultural factors, except for minority status, were associated with 30-day readmission when no mediators were included (p<0.05). Multiple mediation analysis indicated significant indirect effects of the cultural factors on readmission through the hospital discharge practices and CTM. Finally, when the mediators were included, strong direct and indirect effects between minority status and readmission were found (B coefficient=−0.95; p=0.021).

Conclusions The results show that the association between patients’ cultural factors and 30-day readmission is mediated by the hospital discharge practices and care transition. Providing high-quality discharge planning tailored to patients’ cultural characteristics is associated with better care-transition preparedness, which, in turn, is associated with reduced 30-day readmissions.

  • cultural and linguistic factors
  • minorities
  • discharge practices
  • care-transition preparedness
  • 30-day readmission

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  • Contributors All authors meet the criteria for authorship and all those entitled to authorship are listed as authors. NRG drafted the manuscript, analysed and interpreted the data and obtained funding for the original study. ES participated in drafting the manuscript and interpreting the data. BT and RB provided critical revisions for the manuscript. All authors approved the final version of the manuscript.

  • Funding This study was funded by Scholarship from the Israeli Council for Higher Education (Planning & Budgeting Committee) for excellent Arab and minority doctoral students.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board approvals were received from the medical centre, from Clalit’s central ethics committees and from the University's institutional review board.

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

  • Data sharing statement No data are available.

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