Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice

Abstract

BackgroundPeople use emergency department services for a wide variety of health complaints, many of which could be handled outside hospitals. Many frequent readmissions are due to problems with chronic disease and are preventable. We postulated that patient related factors such as the type of condition, demographic factors, access to alternative services outside hospitals and patient preference for hospital or non-hospital services would influence readmissions for chronic disease. This study aimed to explore the link between frequent readmissions in chronic disease and these patient related factors.MethodsA retrospective analysis was performed on emergency department data collected from a regional hospital in NSW Australia in 2008. Frequently readmitted patients were defined as those with three or more admissions in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on readmissions using multivariate analysis.ResultsThe emergency department received about 20,000 presentations a year involving some 16,000 patients. Most patients (80%) presented only once. In 2008 one hundred and forty four patients were readmitted three or more times in a year. About 20% of all presentations resulted in an admission. Frequently readmitted patients were more likely to be older, have an urgent Triage classification, present with an unplanned returned visit and have a diagnosis of neurosis, chronic obstructive pulmonary disease, dyspnoea or chronic heart failure. The chronic ambulatory care sensitive conditions were strongly associated with frequent readmissions. Frequent readmissions were unrelated to gender, time, day or season of presentation or country of birth.ConclusionsMultivariate analysis of routinely collected hospital data identified that the factors associated with frequent readmission include the type of condition, urgency, unplanned return visit and age. Interventions to improve patient uptake of chronic disease management services and improving the availability of alternative non-hospital services should reduce the readmission rate in chronic disease patients.

Multidisciplinary care: experience of patients with complex needs

“…Patients with inadequate health literacy are generally those with fewer economic resources, have low English proficiency, are older with lower levels of basic literacy skills (Kirby et al 2012;Schillinger et al 2002). They are the ones who are less likely to independently navigate the health system or have the confidence to work with health professionals in taking up health-promoting behaviours (Kirby et al 2010).…”

“…Studies have shown that patients from disadvantaged areas are especially vulnerable to poor diabetes outcomes (Schillinger et al 2002) and they are often the people who experience more problems accessing and navigating the system and may result in them using the emergency department (ED) to manage their chronic disease (Kirby et al 2010). This paper aims to describe the views and experiences of patients regarding the multidisciplinary care they received for their diabetes and the facilitators and barriers to taking part in this care.…”

Potentially Preventable 30-Day Hospital Readmissions at a Children’s Hospital

“…12,13 In addition, some argue that hospitals should not be held accountable for readmissions because factors that contribute to readmissions often are not hospital factors (eg, postoperative complication) but instead are outpatient (eg, nurse unable to visit home) or patient (eg, not taking prescribed medications) factors and thus beyond the hospital's direct control. 14,15 Currently, 3 main strategies for ascertaining the potential preventability of hospital readmissions include the following: claims-based algorithms, medical record review, and structured interviews. Claims-based algorithms are perceived to be limited in identifying reasons for readmission.…”

Elderly Care Unit Ready for Sensitive Conditions to Primary Health Care

“…17,18 A predominância do sexo feminino encontrado nesta pesquisa é análoga ao que a literatura expõe. 18,19 Tal episódio pode ser justificado pela caracterís-tica cultural que a mulher carrega, pelos laços maternais, sendo vista como símbolo de cuidado.…”

“…Tal fato chama a atenção, pois o acompanhamento das DCNTs deve acontecer prioritariamente na APS, 17 levando a questionamentos sobre a influência do víncu-lo que este nível de atenção possui, uma vez que a aferição de sinais vitais é técnica básica para o cuidado ao idoso.…”