Factors Contributing to All-cause 30-day Readmissions
- 1 July 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medical Care
- Vol. 50 (7), 599-605
- https://doi.org/10.1097/mlr.0b013e318249ce72
Abstract
To understand factors leading to all-cause 30-day readmissions in a community hospital population. Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team. Eighteen Kaiser Permanente Northern California hospitals. Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management. Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified.Keywords
This publication has 33 references indexed in Scilit:
- Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: A mixed methods studyJournal of Hospital Medicine, 2010
- Rapid spread of complex change: a case study in inpatient palliative careBMC Health Services Research, 2009
- Electronic Versus Dictated Hospital Discharge Summaries: a Randomized Controlled TrialJournal of General Internal Medicine, 2009
- Rehospitalizations among Patients in the Medicare Fee-for-Service ProgramThe New England Journal of Medicine, 2009
- Can home visits help reduce hospital readmissions? Randomized controlled trialJournal of Advanced Nursing, 2008
- Redefining and Redesigning Hospital Discharge to Enhance Patient Care: A Randomized Controlled StudyJournal of General Internal Medicine, 2008
- Objectively Measured, but Not Self-Reported, Medication Adherence Independently Predicts Event-Free Survival in Patients With Heart FailureJournal of Cardiac Failure, 2008
- Post-Acute Referral Decisions Made by Multidisciplinary Experts Compared to Hospital Clinicians and the Patients’ 12-Week OutcomesMedical Care, 2008
- Classifying general medicine readmissionsJournal of General Internal Medicine, 1996
- Factors affecting early unplanned readmission of elderly patients to hospital.BMJ, 1988