Jeffs Lianne, Dhalla Irfan, Cardoso Roberta, Bell Chaim M
Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto, Ontario , Canada and.
J Interprof Care. 2014 Nov;28(6):507-12. doi: 10.3109/13561820.2014.923988. Epub 2014 Jun 10.
An understanding of what complex medical patients with chronic conditions, family members and healthcare professionals perceive to be the key reasons for the readmission is important to preventing their occurrence. In this context, we undertook a study to understand the perceptions of patients, family members and healthcare professionals regarding the reasons for, and preventability of, readmissions. An exploratory case design with semi-structured interviews was conducted with 49 participants, including patients, family members, nurses, case managers, physicians, discharge planners from a general internal medicine unit at a large and academic hospital. Data were analyzed using a directed content analysis approach that involved three investigators. Two contrasting themes emerged from the analysis of interview data set. The first theme was readmissions as preventable occurrences. Our analyses elucidated contributing factors to readmissions during the patients' hospital stay and after the patients were discharged. The second theme was readmissions as inevitable, occurring due to the progression of disease. Our study findings indicate that some readmissions are perceived to be inevitable due to the burden of disease while others are perceived to be preventable and associated with factors both in hospital and post-discharge. Continued interprofessional efforts are required to identify patients at risk for readmission and to organize and deliver care to improve health outcomes after hospitalization.
了解患有慢性病的复杂医疗患者、家庭成员和医护人员认为再入院的关键原因，对于预防再入院的发生很重要。在此背景下，我们开展了一项研究，以了解患者、家庭成员和医护人员对再入院原因及可预防性的看法。我们采用探索性案例设计并进行了半结构化访谈，访谈对象有49名参与者，包括患者、家庭成员、护士、病例管理人员、医生以及一家大型学术医院普通内科病房的出院计划制定人员。数据由三名研究人员采用定向内容分析法进行分析。从访谈数据集的分析中出现了两个截然不同的主题。第一个主题是再入院是可预防的情况。我们的分析阐明了患者住院期间及出院后导致再入院的因素。第二个主题是再入院是不可避免的，是疾病进展所致。我们的研究结果表明，由于疾病负担，一些再入院被认为是不可避免的，而另一些则被认为是可预防的，且与住院期间和出院后的因素有关。需要持续的跨专业努力来识别有再入院风险的患者，并组织和提供护理，以改善住院后的健康结局。
