IMPORTANCE Readmission penalties have catalyzed efforts to improve care transitions, but few programs have incorporated viewpoints of patients and health care professionals to determine readmission preventability or to prioritize opportunities for care improvement. OBJECTIVES To determine preventability of readmissions and to use these estimates to prioritize areas for improvement. DESIGN, SETTING, AND PARTICIPANTS An observational study was conducted of 1000 general medicine patients readmitted within 30 days of discharge to 12 US academic medical centers between April 1, 2012, and March 31, 2013. We surveyed patients and physicians, reviewed documentation, and performed 2-physician case review to determine preventability of and factors contributing to readmission. We used bivariable statistics to compare preventable and nonpreventable readmissions, multivariable models to identify factors associated with potential preventability, and baseline risk factor prevalence and adjusted odds ratios (aORs) to determine the proportion of readmissions affected by individual risk factors. MAIN OUTCOME AND MEASURE Likelihood that a readmission could have been prevented. RESULTS The study cohort comprised 1000 patients (median age was 55 years). Of these, 269 (26.9%) were considered potentially preventable. In multivariable models, factors most strongly associated with potential preventability included emergency department decision making regarding the readmission (aOR, 9.13; 95% CI, 5.23–15.95), failure to relay important information to outpatient health care professionals (aOR, 4.19; 95% CI, 2.17–8.09), discharge of patients too soon (aOR, 3.88; 95% CI, 2.44–6.17), and lack of discussions about care goals among patients with serious illnesses (aOR, 3.84; 95% CI, 1.39–10.64). The most common factors associated with potentially preventable readmissions included emergency department decision making (affecting 9.0%; 95% CI, 7.1%−10.3%), inability to keep appointments after discharge (affecting 8.3%; 95% CI, 4.1%−12.0%), premature discharge from the hospital (affecting 8.7%; 95% CI, 5.8%–11.3%), and patient lack of awareness of whom to contact after discharge (affecting 6.2%; 95% CI, 3.5%–8.7%). CONCLUSIONS AND RELEVANCE Approximately one-quarter of readmissions are potentially preventable when assessed using multiple perspectives. High-priority areas for improvement efforts include improved communication among health care teams and between health care professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management.

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Background Health research is evolving to include patient stakeholders (patients, families and caregivers) as active members of research teams. Frameworks describing the conceptual foundations underlying this engagement and strategies detailing best practice activities to facilitate engagement have been published to guide these efforts. Objective The aims of this narrative review are to identify, quantify and summarize (a) the conceptual foundational principles of patient stakeholder engagement in research and (b) best practice activities to support these efforts. Search Strategy, Inclusion Criteria, Data Extraction and Synthesis We accessed a publicly available repository of systematically identified literature related to patient engagement in research. Two reviewers independently screened articles to identify relevant articles and abstracted data. Main Results We identified 990 potentially relevant articles of which 935 (94.4%) were excluded and 55 (5.6%) relevant. The most commonly reported foundational principles were “respect” (n = 25, 45%) and “equitable power between all team members” (n = 21, 38%). Creating “trust between patient stakeholders and researchers” was described in 17 (31%) articles. Twenty‐seven (49%) articles emphasized the importance of providing training and education for both patient stakeholder and researchers. Providing financial compensation for patient stakeholders’ time and expertise was noted in 19 (35%) articles. Twenty articles (36%) emphasized regular, bidirectional dialogue between patient partners and researchers as important for successful engagement. Discussion and Conclusions Engaging patient stakeholders in research as partners presents an opportunity to design, implement and disseminate patient‐centred research. This review creates an overarching foundational framework for authentic and sustainable partnerships between patient stakeholders and researchers.

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Background: Many experts believe that hospitals with more frequent hospital readmissions provide lower quality of care, but little is known about how the preventability of readmissions might change over the post-discharge timeframe. Objective: To determine whether readmissions within 7 days of discharge are different from readmissions between 8 and 30 days after discharge with respect to preventability. Design: Prospective cohort study. Setting: 10 US academic medical centers. Patients: 822 adults readmitted to a general medicine service. Measurements: At each site, 2 physician assessors used a structured survey instrument to determine whether each readmission was preventable and to measure other characteristics of the readmission. Results: 36.2% of early readmissions versus 23.0% of late readmissions were preventable (median risk difference 13.0%, 25th, 75th percentile 5.5, 26.4). The hospital was identified as a better location to prevent an early readmission than a late readmission (47.2% vs. 25.5%, [median risk difference 22.8%, 25th, 75th percentile 17.9, 31.8]). In contrast, the outpatient clinic (15.2% vs. 6.6%, [median risk difference 10%, 25th, 75th percentile 4.6, 12.2]) and home (19.4% vs. 14%, [median risk difference 5.6%, 25th, 75th percentile −6.1, 17.1]) were identified as better locations to prevent late readmissions than early readmissions. Limitations: Physician assessors were not blinded to readmission timing. In addition, community hospitals were not included in the study, and readmissions to non-study hospitals were not included in the results. Conclusions: Early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.