Carter Jocelyn, Ward Charlotte, Thorndike Anne, Donelan Karen, Wexler Deborah J
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Patient Exp. 2020 Feb;7(1):19-26. doi: 10.1177/2374373518825143. Epub 2019 Feb 7.
Preventable hospital readmissions are costly and erode the quality of care delivery. Few efforts to incorporate the patient perspectives and social factors associated with readmission preventability exist.
To identify patient perceptions and social barriers to care related to readmission.
Prospective cohort study of 202 respondents readmitted within 30 days of hospital discharge from 2 inpatient adult medicine units at Massachusetts General Hospital, Boston, Massachusetts between January 2012 and January 2016.
Few participants indicated that their readmission was due to unattainable health care after discharge. Almost half indicated that they needed more general assistance to stay well outside the hospital. Those reporting a barrier related to at least 2 measures of social determinants of health were more likely to have preventable readmissions (34% vs 17%, = .006). Participants with a history of homelessness or substance use disorder were more likely to have preventable readmissions (44% vs 20%, = .04 and 32% vs 18%, = .03, respectively).
Strengthening nonmedical support systems and general social policy may be required to reduce preventable readmissions.
可预防的医院再入院成本高昂，并会降低医疗服务质量。目前很少有努力将患者观点以及与再入院可预防性相关的社会因素纳入其中。
确定患者对与再入院相关的护理的看法和社会障碍。
对2012年1月至2016年1月期间在马萨诸塞州波士顿市马萨诸塞州总医院两个成人内科住院部出院后30天内再次入院的202名受访者进行前瞻性队列研究。
很少有参与者表示他们的再次入院是由于出院后无法获得医疗保健。近一半的人表示他们需要更多的一般援助以在院外保持健康。那些报告与至少两项健康社会决定因素措施相关障碍的人更有可能出现可预防的再入院情况（34%对17%，P = .006）。有无家可归或物质使用障碍病史的参与者更有可能出现可预防的再入院情况（分别为44%对20%，P = .04和32%对18%，P = .03）。
可能需要加强非医疗支持系统和一般社会政策以减少可预防的再入院情况。
