Dietrich Eric, Davis Kyle, Chacko Lisa, Rahmanian Kiarash P, Bielick Lauren, Quillen David, Feller David, Porter Maribeth, Malaty John, Carek Peter J
From the Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, the Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, and the Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville.
South Med J. 2019 Apr;112(4):244-250. doi: 10.14423/SMJ.0000000000000959.
Factors contributing to hospital readmission have rarely been sought from the patient perspective. Furthermore, it is unclear how patients and physicians compare in identifying factors contributing to readmission. The objective of the study was to identify and compare factors contributing to hospital readmission identified by patients and physicians by surveying participants upon hospital readmission to a teaching medicine service.
Patients 18 years and older who were discharged and readmitted to the same service within 30 days and the physicians caring for these patients were surveyed to identify factors contributing to readmission. Secondary outcomes included comparing responses between groups and determining level of agreement. Patients could be surveyed multiple times on subsequent readmissions; physicians could be surveyed for multiple patients.
A total of 131 patients and 37 physicians were consented. The mean patient age was 60.1 years (standard deviation 16.8 years) and 55.6% were female; 56.4% were white, and 42.1% were black/African American. In total, 179 patient surveys identified "multiple medical problems" (48.6%), "trouble completing daily activities" (45.8%), and "discharged too soon" (43.6%) most frequently as contributing factors; 231 physician surveys identified "multiple medical problems" (45.0%) and "medical condition too difficult to care for at home" (35.6%) most frequently as contributing factors. Paired survey results were available for 135 readmissions and showed fair agreement for only 1 factor but no agreement for 5 factors.
Patients identified previously unknown factors contributing to readmission. Little agreement existed between patients and physicians. Additional research is needed to determine how best to address patient-identified factors contributing to readmission.
导致再次入院的因素很少从患者的角度去探寻。此外，目前尚不清楚患者和医生在识别导致再次入院的因素方面有何差异。本研究的目的是通过对教学医学服务部门再次入院的参与者进行调查，识别并比较患者和医生所指出的导致再次入院的因素。
对18岁及以上在30天内出院并再次入住同一科室的患者以及负责照顾这些患者的医生进行调查，以确定导致再次入院的因素。次要结果包括比较两组之间的回答，并确定一致程度。患者在随后的再次入院时可以接受多次调查；医生可以针对多名患者接受调查。
共有131名患者和37名医生同意参与。患者的平均年龄为60.1岁（标准差16.8岁），55.6%为女性；56.4%为白人，42.1%为黑人/非裔美国人。总共179份患者调查问卷最常将“多种医疗问题”（48.6%）、“完成日常活动困难”（45.8%）和“出院过早”（43.6%）列为导致再次入院的因素；231份医生调查问卷最常将“多种医疗问题”（45.0%）和“病情在家中难以照料”（35.6%）列为导致再次入院的因素。有135次再次入院的配对调查结果，结果显示只有1个因素达成了中等程度的一致，但有5个因素未达成一致。
患者指出了导致再次入院的一些此前未知的因素。患者和医生之间几乎没有达成一致。需要进一步研究以确定如何最好地解决患者指出的导致再次入院的因素。
