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Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries
  1. Louise S van Galen1,
  2. Mikkel Brabrand2,
  3. Tim Cooksley3,
  4. Peter M van de Ven4,
  5. Hanneke Merten5,
  6. Ralph KL So6,
  7. Loes van Hooff7,
  8. Harm R Haak8,9,
  9. Rachel M Kidney10,
  10. Christian H Nickel11,
  11. John TY Soong12,
  12. Immo Weichert13,
  13. Mark HH Kramer1,
  14. Christian P Subbe14,
  15. Prabath WB Nanayakkara1
  16. On behalf of the Safer@home consortium
  1. 1 Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
  2. 2 Department of Emergency Medicine, Hospital of South West Jutland, Denmark
  3. 3 Department of Acute Medicine, University Hospital of South Manchester, Manchester, United Kingdom
  4. 4 Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
  5. 5 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
  6. 6 Department of Quality, Safety and Innovation, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands
  7. 7 Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Limburg, The Netherlands
  8. 8 Department of Internal Medicine, Maxima Medisch Centre, Eindhoven/Veldhoven, The Netherlands
  9. 9 Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  10. 10 Department of Acute Medicine, St. James Hospital, Dublin, Ireland
  11. 11 Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
  12. 12 Imperial College London, NIHR CLAHRC for Northwest London, London, UK
  13. 13 Department of Acute Medicine, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom
  14. 14 Department of Acute Medicine, Ysbyty Gwynedd Hospital, Wales, United Kingdom
  1. Correspondence to Dr Prabath WB Nanayakkara, Department of Internal Medicine, VU university medical center, Amsterdam 1081 HZ, The Netherlands; p.nanayakkara{at}


Objectives Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions.

Design Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen’s Kappa measured pairwise agreement of considering readmission as predictable/preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability.

Setting 15 hospitals in four European countries

Participants 1398 medical patients readmitted unscheduled within 30 days

Main Outcome(s) and Measure(s) (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions.

Results The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49).

Conclusions There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients’ readiness to go home timely before discharge.

  • Communication
  • Healthcare quality improvement
  • Hospital medicine
  • Human factors
  • Patient-centred care

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  • Competing interests None declared.

  • Patient consent All patients included in this study signed informed consent form before inclusion. This informed consent form was composed by our group and approved by the ethical committee.

  • Ethics approval Primary approval was obtained from the Medical Ethical Committee of the VU Medical Center (ID: 2015.293). The Medical Ethics Review Committee of VU University Medical Center is registered with the US Office for Human Research Protections (OHRP) as IRB00002991. The FWA number assigned to VU University Medical Center is FWA00017598. Using this declaration other participating centres received local approval. In the UK ethics approval was obtained from the Wales Research Ethics Committee 5, Bangor (ID: 15/WA/0424). In Denmark ethical approval was obtained from The Secretariat of the Regional Committees on Health Research Ethics for Southern Denmark (ID: S-20152000-115 CSF). In Ireland ethical approval was obtained from the SJH/AMNHCH Research Ethics Committee (ID: 2015-03 Chairman’s Action (17)).

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

  • Data sharing statement Anonymised full data set and statistical codes are available to readers on request.

  • Collaborators Safer@home collaborator group (alphabetically ordered): L Ackermans, A B Arntzenius, D G Barten, M H van derBie, T Boeije, D A Chamles, E Chaudhuri, M Diepenbroek-Meekes, D P Cooper, E M Durinck,J A van Erven, T A Graaff-de Kooter, F Holleman, J Huussen, W Jansen, J JJensen, J Kellet, T Knol, I Lee, T S van Lieshout, A J Meinders, N EMullaart-Jansen, S C van Nassau, J L Pedersen, R O Jensen, A Pronk, M R Kristensen,A M Ridge, T C Roeleveld, M C Schipper, D Vedder, J P van der Vorst, J Wachelder.

  • Correction notice This article has been corrected since it first published Online First. The collaborator list has been included,