Was This Readmission Preventable? Qualitative Study of Patient and Provider Perceptions of Readmissions. Issue 6 (June 2016) - Stein, Jacob
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. Abstract : We conducted a prospective chart review and qualitative interviews with patients and providers regarding readmissions. We found that providers and patients had differing perspectives of the preventability and contributing factors behind readmissions, and that providers more frequently than patients themselves saw readmissions as preventable. Follow-up, substance abuse, and mental health emerged as frequently cited factors driving readmission, and these offer potential strategies for the prevention of rehospitalization.Supplemental digital content is available in the text.