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Med Care. 2012 Jul;50(7):599-605. doi: 10.1097/MLR.0b013e318249ce72.

Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals.

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1
The Permanente Medical Group, USA.

Abstract

OBJECTIVE:

To understand factors leading to all-cause 30-day readmissions in a community hospital population.

RESEARCH DESIGN:

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.

SETTING:

Eighteen Kaiser Permanente Northern California hospitals.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
22354212
DOI:
10.1097/MLR.0b013e318249ce72
[Indexed for MEDLINE]

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