Collections > Master's Papers > Gillings School of Public Health > Hospital Readmissions from Patients’ Perspectives and A Potential Link Between Hospitalizations and Population Health

Background: Health care expenditures in the United States have been increasing exponentially while hospital care accounts for one-third of the costs. Approximately 20% of hospitalized Medicare beneficiaries are being readmitted within 30 days following their discharge which further increases these costs. Despite the use of various peridischarge interventions that focus on patient education, discharge planning, close follow-up appointments, and medication reconciliation endeavors, readmission rates continue to be high. As a quality measure, penalties for high rates are inversely affecting the reimbursements. Currently, research on the factors contributing to hospital readmissions are mostly derived from cohort studies or chart reviews through the views of health care providers, however few studies include patients’ perspectives. We believe that engaging patients in the discharge planning process can help better identify patients’ post-discharge needs and therefore implement more effective readmission prevention strategies. Objective: To identify the factors contributing to hospital readmissions from patients’ perspectives in a large urban community hospital in Charlotte, North Carolina. Methods: We evaluated all consecutive, unplanned readmissions to the hospitalist service within 30 days of discharge between February 23, 2016 - April 25, 2016, using the State Action on Avoidable Rehospitalizations (STAAR) diagnostic tool worksheet along with face-to-face patient interviews and retrospective chart reviews from the Electronic Health Records (EHR). Results: During the study period, 80 patients were readmitted within 30 days of their discharge with 28 of them having more than one readmission. The mean age was 50.8±18.3 (19-98) years. Of the 80 patients, 51% were male. Similarly, 51% were black. Sickle cell disease was the top diagnosis (11.3%) in both index admission and readmission; while among super-utilizers (patients with greater than one readmission) this rate was even higher (25%). Predixion scores were found to be reliable, correctly identifying the high-risk population for readmission. The number of days between admissions was 12.6± 8.1 (1-28) with a peak at the seventh day of discharge. Patient interviews identified some modifiable risk factors for readmissions such as the inability to obtain medications or make follow-up appointments, and problems related to transportation, housing, and social support. While 41% had some type of limited functional status, only 20% of patients had home health care at discharge. Despite clear discharge planning and patient understanding of the plan by teach-back method being recorded at discharge, almost one-third of patients appeared to lack the ability to self-manage symptoms and understand the disease process. Conclusions: The causes of readmissions are multifactorial in the face of an aging population with multiple complex medical problems. While comprehensive peridischarge interventions are one way to reduce readmission rates, our study demonstrated that certain patient populations require tailored approaches. Engaging patients in the discharge planning process can help identify and address barriers that may otherwise be missed. In patients with low socioeconomic status (SES), improvement in social, economic, and environmental layers of population health have the potential to prevent hospitalizations and readmissions in the long term. Multisectoral collaborations between health care systems, public health and hospital-community partnerships are required to align goals and initiatives to assure the success of healthy people in healthy communities.