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BMJ Qual Saf. 2017 Dec;26(12):958-969. doi: 10.1136/bmjqs-2017-006645. Epub 2017 Jun 22.

Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries.

Author information

1
Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
2
Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
3
Department of Acute Medicine, University Hospital of South Manchester, Manchester, United Kingdom.
4
Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
5
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
6
Department of Quality, Safety and Innovation, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands.
7
Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Limburg, The Netherlands.
8
Department of Internal Medicine, Maxima Medisch Centre, Eindhoven/Veldhoven, The Netherlands.
9
Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
10
Department of Acute Medicine, St. James Hospital, Dublin, Ireland.
11
Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland.
12
Imperial College London, NIHR CLAHRC for Northwest London, London, UK.
13
Department of Acute Medicine, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom.
14
Department of Acute Medicine, Ysbyty Gwynedd Hospital, Wales, United Kingdom.

Abstract

OBJECTIVES:

Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions.

DESIGN:

Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen's Kappa measured pairwise agreement of considering readmission as predictable/preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability.

SETTING:

15 hospitals in four European countries PARTICIPANTS: 1398 medical patients readmitted unscheduled within 30 days MAIN OUTCOMES AND MEASURES: (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions.

RESULTS:

The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49).

CONCLUSIONS:

There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.

KEYWORDS:

Communication; Healthcare quality improvement; Hospital medicine; Human factors; Patient-centred care

PMID:
28642333
DOI:
10.1136/bmjqs-2017-006645
[Indexed for MEDLINE]

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