Journal article
Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries.
- van Galen LS Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
- Brabrand M Department of Emergency Medicine, Hospital of South West Jutland, Denmark.
- Cooksley T Department of Acute Medicine, University Hospital of South Manchester, Manchester, United Kingdom.
- van de Ven PM Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
- Merten H Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
- So RK Department of Quality, Safety and Innovation, Albert Schweitzer Ziekenhuis, Dordrecht, Zuid-Holland, The Netherlands.
- van Hooff L Department of Emergency Medicine, VieCuri Medical Centre, Venlo, Limburg, The Netherlands.
- Haak HR Department of Internal Medicine, Maxima Medisch Centre, Eindhoven/Veldhoven, The Netherlands.
- Kidney RM Department of Acute Medicine, St. James Hospital, Dublin, Ireland.
- Nickel CH Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland.
- Soong JT Imperial College London, NIHR CLAHRC for Northwest London, London, UK.
- Weichert I Department of Acute Medicine, The Ipswich Hospital NHS Trust, Ipswich, United Kingdom.
- Kramer MH Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
- Subbe CP Department of Acute Medicine, Ysbyty Gwynedd Hospital, Wales, United Kingdom.
- Nanayakkara PW Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
- 2017-06-24
Published in:
- BMJ quality & safety. - 2017
Communication
Healthcare quality improvement
Hospital medicine
Human factors
Patient-centred care
Adolescent
Adult
Aged
Aged, 80 and over
Attitude to Health
Caregivers
Europe
Female
Health Services Research
Humans
Interviews as Topic
Logistic Models
Male
Middle Aged
Patient Readmission
Patients
Perception
Physicians
Prospective Studies
Surveys and Questionnaires
Young Adult
English
OBJECTIVES
Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions.
DESIGN
Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen's Kappa measured pairwise agreement of considering readmission as predictable/preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability.
SETTING
15 hospitals in four European countries PARTICIPANTS: 1398 medical patients readmitted unscheduled within 30 days MAIN OUTCOMES AND MEASURES: (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions.
RESULTS
The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49).
CONCLUSIONS
There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.
Because of fundamental differences in healthcare systems, US readmission data cannot be extrapolated to the European setting: To investigate the opinions of readmitted patients, their carers, nurses and physicians on predictability and preventability of readmissions and using majority consensus to determine contributing factors that could potentially foresee (preventable) readmissions.
DESIGN
Prospective observational study. Readmitted patients, their carers, and treating professionals were surveyed during readmission to assess the discharge process and the predictability and preventability of the readmission. Cohen's Kappa measured pairwise agreement of considering readmission as predictable/preventable by patients, carers and professionals. Subsequently, multivariable logistic regressionidentified factors associated with predictability/preventability.
SETTING
15 hospitals in four European countries PARTICIPANTS: 1398 medical patients readmitted unscheduled within 30 days MAIN OUTCOMES AND MEASURES: (1) Agreement between the interviewed groups on considering readmissions likely predictable or preventable;(2) Factors distinguishing predictable from non-predictable and preventable from non-preventable readmissions.
RESULTS
The majority deemed 27.8% readmissions potentially predictable and 14.4% potentially preventable. The consensus on predictability and preventability was poor, especially between patients and professionals (kappas ranged from 0.105 to 0.173). The interviewed selected different factors as potentially associated with predictability and preventability. When a patient reported that he was ready for discharge during index admission, the readmission was deemed less likely by the majority (predictability: OR 0.55; 95% CI 0.40 to 0.75; preventability: OR 0.35; 95% CI 0.24 to 0.49).
CONCLUSIONS
There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1136/bmjqs-2017-006645
- PMID 28642333
- Persistent URL
- https://sonar.ch/global/documents/232433
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