Brittan Mark, Albright Karen, Cifuentes Maribel, Jimenez-Zambrano Andrea, Kempe Allison
Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
Hosp Pediatr. 2015 Nov;5(11):559-65. doi: 10.1542/hpeds.2015-0034.
Readmissions are an increasingly recognized quality metric that will likely affect payments to children's hospitals. Our aim was to inform future efforts to reduce readmissions by eliciting parent and provider perceptions of pediatric readmissions.
We interviewed English- and Spanish-speaking parents and inpatient providers of children with medical diagnoses who had unplanned readmissions (≤7 days). Parents were interviewed one-on-one during the readmission. Providers were interviewed in person or by phone within 1 week of the patient's second discharge. Interviewees were queried about their perceptions of the reason for readmission and whether the readmission was preventable. Interview transcripts were analyzed using qualitative content methods. Code categories were developed and emergent themes independently identified by 2 analysts.
The study included 30 readmitted children (median age 17 months, 70% male, 80% White or Hispanic, and 66% publically insured). We interviewed 30 parents (23% Spanish speaking) and 27 discharging or readmitting providers. Parents and providers identified several major factors as causing readmissions, including child related (health and symptoms), parent/family related (adherence to recommended care), provider/team related (medical management), communication difficulties, home supports, and quality of discharge teaching. Parents and providers had differing interpretations of the role or magnitude of these factors. Lack of shared understanding between parents and providers emerged as a potentially important cause of readmissions.
We identified lack of shared understanding and communication difficulties between parents and providers as potential causes of readmission. Further research is needed to determine if improvements in identifying and addressing such problems can reduce pediatric readmissions.
再入院是一个越来越受认可的质量指标，可能会影响儿童医院的支付。我们的目的是通过了解家长和医护人员对儿科再入院的看法，为未来减少再入院的努力提供信息。
我们采访了有医疗诊断且意外再入院（≤7天）儿童的讲英语和西班牙语的家长以及住院医护人员。家长在再入院期间接受一对一访谈。医护人员在患者第二次出院后1周内进行面对面或电话访谈。询问受访者对再入院原因的看法以及再入院是否可预防。使用定性内容分析法分析访谈记录。由两名分析师独立开发编码类别并确定新出现的主题。
该研究纳入了30名再入院儿童（中位年龄17个月，70%为男性，80%为白人或西班牙裔，66%有公共保险）。我们采访了30名家长（23%讲西班牙语）和27名负责出院或再次收治的医护人员。家长和医护人员确定了导致再入院的几个主要因素，包括与儿童相关的（健康和症状）、与家长/家庭相关的（遵循推荐护理）、与医护人员/团队相关的（医疗管理）、沟通困难、家庭支持以及出院指导质量。家长和医护人员对这些因素的作用或重要程度有不同的解读。家长和医护人员之间缺乏共同理解成为再入院的一个潜在重要原因。
我们确定家长和医护人员之间缺乏共同理解和沟通困难是再入院的潜在原因。需要进一步研究以确定识别和解决此类问题的改进措施是否能减少儿科再入院情况。
