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BMJ Open. 2018 Jun 30;8(6):e018200. doi: 10.1136/bmjopen-2017-018200.

Qualitative study of perspectives concerning recent rehospitalisations among a high-risk cohort of veteran patients in Connecticut, USA.

Author information

1
VA Connecticut Healthcare System, West Haven, Connecticut, USA.
2
Yale School of Public Health, New Haven, Connecticut, USA.
3
Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVES:

Veterans Affairs (VA) patients are at risk for rehospitalisation due to their lower socioeconomic status, older age, poor social support or multiple comorbidities. The study explored inpatients' perceptions about factors contributing to their rehospitalisation and their recommendations to reduce this risk.

DESIGN:

Thematic qualitative data analysis of interviews with 18 VA inpatients.

SETTING:

VA Connecticut Healthcare System, West Haven Hospital medical inpatient units.

PARTICIPANTS:

All were aged 18+ years, rehospitalised within 30 days of most recent discharge, medically stable and competent to provide consent.

MEASUREMENTS:

Interviews assessed inpatients' health status after last discharge, reason for rehospitalisation, access to and support from primary care providers (PCP), medication management, home support systems and history of substance use or mental health disorders.

RESULTS:

The mean age was 71.6 years (11.1 SD); all were Caucasian, living on limited budgets, and many had serious medical conditions or histories of mental health disorders. Participants considered structural barriers to accessing PCP and limited PCP involvement in medical decision-making as contributing to their rehospitalisation, although most believed that rehospitalisation had been inevitable. Peridischarge themes included beliefs about premature discharge, inadequate understanding of postdischarge plans and insufficiently coordinated postdischarge services. Most highly valued their VA healthcare but recommended increasing PCPs' involvement and reducing structural barriers to accessing primary and specialty care.

CONCLUSIONS:

Increased PCP involvement in medical decision-making about rehospitalisation, expanded clinic hours, reduced travel distances, improved communications to patients and their families about predischarge and postdischarge plans and proactive postdischarge outreach to high-risk patients may reduce rehospitalisation risk.

KEYWORDS:

general medicine (see internal medicine); internal medicine; primary care; qualitative research

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