Smeraglio Andrea, Heidenreich Paul A, Krishnan Gomathi, Hopkins Joseph, Chen Jonathan, Shieh Lisa
Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Clinical Informatics, Sanford Center for Clinic Informatics, Palo Alto, California, USA.
BMJ Open Qual. 2019 Jan 7;8(1):e000264. doi: 10.1136/bmjoq-2017-000264. eCollection 2019.
To compare patients' and providers' views on contributors to 30-day hospital readmissions.
Analysis of a qualitative interview survey between 18 May-30 June 2015.
Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital.
We conducted 178 interviews of readmitted patients.
We queried opinions of what factors patients believed contributed to their rehospitalisation and compared this with the perspective of the index admission provider. The primary outcome was the view that the readmission was preventable. A review by a RN (nurse) case manager also provided an assessment based on patient report, provider report and chart review.
Patients were more likely to view a readmission as preventable compared with physicians (p<0.0001). Patients identified system issues (defined as factors controlled by the hospital discharge process) as contributors to their readmission in 58% (103/178) of cases while providers identified system issues as the contributor to a patients' readmission in 2% (2/101) of cases. Patients with poor functional status were more likely to feel the cause of their readmission was due to system issues than patients with better functional status (p=0.03). A RN case manager review determined that in 48% (86/178) of cases the system had some amount of contribution to a patient's readmission. There was no significant difference in belief that the readmission was preventable between the RN case manager and the patient (p=0.47).
Readmitted patients often feel that the hospital system contributed to their readmission. Providers did not recognise patient and RN case manager identified issues as contributors to hospital readmissions.
比较患者和医疗服务提供者对30天内再次入院因素的看法。
对2015年5月18日至6月30日期间的定性访谈调查进行分析。
在一家三级医疗学术医院对再次入院患者进行30天再次入院住院期间的访谈。
我们对178名再次入院患者进行了访谈。
我们询问了患者认为哪些因素导致他们再次入院的意见，并将其与首次入院医疗服务提供者的观点进行比较。主要结果是认为再次入院是可预防的观点。注册护士（RN）病例管理员的审查也基于患者报告、医疗服务提供者报告和病历审查提供了评估。
与医生相比，患者更有可能认为再次入院是可预防的（p<0.0001）。患者将系统问题（定义为由医院出院流程控制的因素）确定为58%（103/178）的再次入院病例的促成因素，而医疗服务提供者将系统问题确定为2%（2/101）的患者再次入院病例的促成因素。功能状态较差的患者比功能状态较好的患者更有可能认为他们再次入院的原因是系统问题（p=0.03）。注册护士病例管理员的审查确定，在48%（86/178）的病例中，系统对患者再次入院有一定程度的促成作用。注册护士病例管理员和患者在认为再次入院是可预防的信念方面没有显著差异（p=0.47）。
再次入院的患者通常认为医院系统促成了他们的再次入院。医疗服务提供者没有认识到患者和注册护士病例管理员确定的问题是医院再次入院的促成因素。
