Original Article

CME Article: Comparison of Factors Identified by Patients and Physicians Associated with Hospital Readmission (COMPARE2)

Authors: Eric Dietrich, PharmD, BCPS, Kyle Davis, PharmD, BCPS, Lisa Chacko, MD, MPH, Kiarash P. Rahmanian, MPH, Lauren Bielick, BSN, RN, David Quillen, MD, David Feller, MD, Maribeth Porter, MD, MS, John Malaty, MD, Peter J. Carek, MD, MS

Abstract

Objective: Factors contributing to hospital readmission have rarely been sought from the patient perspective. Furthermore, it is unclear how patients and physicians compare in identifying factors contributing to readmission. The objective of the study was to identify and compare factors contributing to hospital readmission identified by patients and physicians by surveying participants upon hospital readmission to a teaching medicine service.

Methods: Patients 18 years and older who were discharged and readmitted to the same service within 30 days and the physicians caring for these patients were surveyed to identify factors contributing to readmission. Secondary outcomes included comparing responses between groups and determining level of agreement. Patients could be surveyed multiple times on subsequent readmissions; physicians could be surveyed for multiple patients.

Results: A total of 131 patients and 37 physicians were consented. The mean patient age was 60.1 years (standard deviation 16.8 years) and 55.6% were female; 56.4% were white, and 42.1% were black/African American. In total, 179 patient surveys identified “multiple medical problems” (48.6%), “trouble completing daily activities” (45.8%), and “discharged too soon” (43.6%) most frequently as contributing factors; 231 physician surveys identified “multiple medical problems” (45.0%) and “medical condition too difficult to care for at home” (35.6%) most frequently as contributing factors. Paired survey results were available for 135 readmissions and showed fair agreement for only 1 factor but no agreement for 5 factors.

Conclusions: Patients identified previously unknown factors contributing to readmission. Little agreement existed between patients and physicians. Additional research is needed to determine how best to address patient-identified factors contributing to readmission.

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