Understanding patient-centred readmission factors: a multi-site, mixed-methods study

In BMJ Quality & Safety, Ryan Greysen and colleagues characterize patient- and caregiver-reported factors that contribute to hospital readmissions in general medicine patients. While patient concerns at or before discharge inform many transitional care interventions, few studies examine patients’ perceptions of self-care and other factors related to readmission. The authors surveyed more than 1,000 patient readmitted to 12 hospitals, with multiple choice and open-ended questions that assessed post-discharge difficulty in seven domains of self-care. These domains included medication use, contacting providers, transportation, basic needs, diet, social support, and substance abuse. They find that, while 91% of patients reported understanding their discharge plan, only 37% were asked by their providers about barriers to carrying out the plan. More than half 52% reported experiencing difficulty in one or more self-care domains, and 26% experienced difficulty in two or more domains. Very few patients attributed their readmission to early discharge (8%), poor-quality hospital care (6%), or inadequate discharge instructions or follow-up care (6%). These findings suggest that patients readmitted within 30 days understand their discharge plans, but experience frequent difficulties in self-care and have low anticipatory guidance for resolving these issues after discharge.