Original Article

Was This Readmission Preventable? Qualitative Study of Patient and Provider Perceptions of Readmissions

Authors: Jacob Stein, MD, MPH, Paul Ossman, MD, MPH, Anthony Viera, MD, MPH, Carlton Moore, MD, MS, Beth Ann Brubaker, MD, John French, BA, Edmund Allen Liles, MD

Abstract

Objectives: Readmissions are a costly, burdensome, and potentially preventable occurrence in the healthcare system. With the renewed national focus on the cost and quality of health care, readmissions have become a major target for improvement; however, in general, the viewpoints of patients and healthcare providers have not been considered in these discussions. We aimed to compare provider and patient perspectives on the preventability of hospital readmissions. We also aimed to compare the factors that patients and providers perceive as contributing to readmissions.

Methods: We conducted descriptive statistics of readmissions using provider chart reviews (N = 213) on all readmissions to the University of North Carolina hospitalist service during a 6-month span. We also performed a qualitative analysis of those provider chart reviews, in addition to interviews with those readmitted patients (n = 23). We compared the percentage of providers versus patients who believed the readmission was preventable, and we explored the factors to which each group attributed the readmission.

Results: Providers stated that 30% of the readmissions were preventable, compared with only 13% of patients. Key contributing factors differed between providers and patients. Providers cited medical problems in 45% of readmissions, pain (24%), follow-up problems (22%), substance abuse (20%), and nonadherence (17%). Patients believed nothing could have been done to prevent them in 35% of readmissions, but they also cited medical problems (35%), incomplete diagnosis or treatment (22%), medication issues (17%), and system concerns (13%) as contributing to readmissions.

Conclusions: These data suggest that patients and providers view the issue of readmissions differently and highlight potential areas for improvement.

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References

1. US Congress. Patient Protection and Affordable Care Act. http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html. Accessed March 22, 2016.
 
2. Brill S. Bitter pill: why medical bills are killing us. http://time.com/198/bitterpill-why-medical-bills-are-killing-us. Published April 4, 2013. Accessed March 22, 2016.
 
3. Centers for Medicare & Medicaid Services. Readmissions reduction program (HRRP). http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Modified February 2, 2016. Accessed March 22, 2106.
 
4. Kansagara D, Englander H, Salanitro A, et al. Risk prediction models for hospital readmission: a systematic review. JAMA 2011;306:1688-1698.
 
5. Hasan O, Meltzer DO, Shaykevich SA, et al. Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med 2010;25:211-219.
 
6. Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006;166:1822-1828.
 
7. van Walraven C, Bennett C, Jennings A, et al. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ 2011;183:E391-E402.
 
8. Bianco A, Mole A, Nobile CG, et al. Hospital readmission: prevalence and analysis of those potentially avoidable in southern Italy. PLoS One 2012; 7:e48263.
 
9. Yam CH, Wong EL, Chan FW, et al. Measuring and preventing potentially avoidable hospital readmissions: a review of the literature. Hong Kong Med J 2010;16:383-389.
 
10. Boutwell A, Jencks S, Nielsen GA, et al. STate Action on Avoidable Rehospitalizations (STAAR) Initiative: applying early evidence and experience in front-line process improvements to develop a state-based strategy. http://www.ihi.org/engage/initiatives/Completed/STAAR/Documents/STAAR%20State%20Based%20Strategy.pdf. Published 2009. Accessed March 22, 2016.
 
11. Richards L. Handling Qualitative Data: A Practical Guide. 1st ed. Thousand Oaks, CA: Sage Publications; 2005.
 
12. Bisharat N, Handler C, Schwartz N. Readmissions to medical wards: analysis of demographic and socio-medical factors. Eur J Intern Med 2012;23:457-460.
 
13. Jasti H, Mortensen EM, Obrosky DS, et al. Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis 2008;46:550-556.
 
14. Horwitz LI, Moriarty JP, Chen C, et al. Quality of discharge practices and patient understanding at an academic medical center. JAMA Intern Med 2013;173:1715-1722.
 
15. Annema C, Luttik ML, Jaarsma T. Reasons for readmission in heart failure: perspectives of patients, caregivers, cardiologists, and heart failure nurses. Heart Lung 2009;38:427-434.
 
16. Ghali JK, Kadakia S, Cooper R, et al. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med 1988;148:2013-2016.
 
17. Aron L, Honberg R, Duckworth K, et al. Grading the states 2009: a report on America’s health care system for adults with serious mental illness. http://www.nami.org/grades. Accessed March 22, 2016.