Readmissions in the Era of Patient Engagement

Howard‐Anderson, Jessica; Lonowski, Sarah; Vangala, Sitaram; Tseng, Chi‐Hong; Busuttil, Ashley; Afsarmanesh, Nasim

doi:10.1001/jamainternmed.2014.4782

Cited by 35 publications

(43 citation statements)

References 4 publications

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“…Furthermore, including the patient's perspective on preventability would be useful, especially given reports of poor agreement between physicians and patients regarding preventability of their readmissions. 13 Second, our study was conducted at a single site, thereby limiting its generalizability. It would be a logical next step to deploy this method in different settings, to include additional services in differing types of hospitals (academic, rural, community, etc.).…”

Section: Discussionmentioning

confidence: 99%

Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators—A Cross-Sectional Analysis

et al. 2016

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BACKGROUND: Rates of preventable admissions will soon be publicly reported and used in calculating performance-based payments. The current method of assessing preventable admissions, the Agency of Healthcare Research and Quality (AHRQ) Preventable Quality Indicators (PQI) rate, is drawn from claims data and was originally designed to assess population-level access to care. OBJECTIVE: To identify the prevalence and causes of preventable admissions by attending physician review and to compare its performance with the PQI tool in identifying preventable admissions. DESIGN: Cross-sectional survey. SETTING: General medicine service at an academic medical center. PARTICIPANTS: Consecutive inpatient admissions from December 1-15, 2013. MAIN MEASURES: Survey of inpatient attending physicians regarding the preventability of the admissions, primary contributing factors and feasibility of prevention. For the same patients, the PQI tool was applied to determine the claims-derived preventable admission rate. KEY RESULTS: Physicians rated all 322 admissions and classified 122 (38 %) as preventable, of which 31 (25 %) were readmissions. Readmissions were more likely to be rated preventable than other admissions (49 % vs. 35 %, p = 0.04). Application of the AHRQ PQI methodology identified 75 (23 %) preventable admissions. Thirty-one admissions (10 %) were classified as preventable by both methods, and the majority of admissions considered preventable by the AHRQ PQI method (44/78) were not considered preventable by physician assessment (K = 0.04). Of the preventable admissions, physicians assigned patient factors in 54 (44 %), clinician factors in 36 (30 %) and system factors in 32 (26 %). CONCLUSIONS: A large proportion of admissions to a general medicine service appeared preventable, but AHRQ's PQI tool was unable to identify these admissions.Before initiation of the PQI rate for use in pay-forperformance programs, further study is warranted.KEY WORDS: preventable admissions; quality indicators; value-based purchasing.

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Section: Discussionmentioning

confidence: 99%

Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators—A Cross-Sectional Analysis

et al. 2016

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“…Patients and their caregivers likely have an important perspective and even expertise as they encounter problems such as fragmentation, inadequate education or social barriers to care. Prior research has examined specific aspects of the hospital discharge process such as patient understanding of discharge instructions, medications, follow-up appointments,6–9 misaligned transition goals,10 unmet needs11 or perceptions about preventability 12. Few studies, however, have focused on the experience of readmitted patients specifically to understand ‘what went wrong’ after discharge from the patient's perspective 13–15.…”

Section: Introductionmentioning

confidence: 99%

Understanding patient-centred readmission factors: a multi-site, mixed-methods study

et al. 2016

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ImportancePatient concerns at or before discharge inform many transitional care interventions; few studies examine patients’ perceptions of self-care and other factors related to readmission.ObjectivesTo characterise patient-reported or caregiver-reported factors contributing to readmission.Design, setting and participantsCross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers.MeasurementsMultiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns.ResultsWe interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%).LimitationsThe study population included only patients readmitted at academic medical centres and may not be representative of community-based care.ConclusionPatients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.

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“…The patient has intimate knowledge of the circumstances surrounding their readmission and can be a valuable resource. This is particularly true given evidence that patient perspectives do not always align with those of providers . Coleman's Care Transitions Intervention was one of the earliest care‐transition models demonstrating value in engaging patients to become actively involved in their care .…”

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confidence: 99%

From discharge to readmission: Understanding the process from the patient perspective

Howard‐Anderson

Busuttil

Lonowski

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Patient engagement is critical in delivering high‐quality care. However, literature investigating patient perspectives on readmissions is lacking. OBJECTIVES To understand patients' beliefs and attitudes about 30‐day readmissions and to elucidate areas for improvement aimed at reducing readmissions. DESIGN In person survey. SETTING Academic medical center and affiliated community hospital. PATIENTS Patients with 30‐day readmissions to medicine and cardiology services. MEASUREMENTS Patient readiness, attitudes toward readmissions, discharge instructions, ambulatory resources, and follow‐up care. RESULTS Of 479 eligible patients approached for interviews, 230 (48%) were interviewed. Of these, 28% reported not feeling ready for discharge, and this correlated with inadequate symptom resolution, poor pain control, and concerns about self‐care. Sixty‐five percent remembered reviewing discharge paperwork, but over 22% could not identify critical information on this paperwork. Eighty‐five percent reported having a primary doctor; however, only 56% of patients who received a contact number on discharge called a physician before returning to the hospital. One‐third of patients knew where to obtain same‐day care outside of the emergency room. Lastly, patients reported feeling more relieved than burdened upon readmission (7.7 [standard deviation {SD} 2.8) vs 5.9 [SD 3.4]; P < 0.001, scale of 1–10). CONCLUSIONS By engaging readmitted patients we have illuminated areas for future interventions, including better symptom management and self‐care planning before discharge, more clarity in discharge instructions, promoting awareness of outpatient resources, and improved alignment of patient and provider attitudes about readmissions. As the United States strives to reduce readmissions, attending to the patient perspective is critical in informing appropriate avenues for quality improvement. Journal of Hospital Medicine 2016;11:407–412. © 2016 Society of Hospital Medicine

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Readmissions in the Era of Patient Engagement

Cited by 35 publications

References 4 publications

Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators—A Cross-Sectional Analysis

Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators—A Cross-Sectional Analysis

Understanding patient-centred readmission factors: a multi-site, mixed-methods study

From discharge to readmission: Understanding the process from the patient perspective

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