Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries

Louise S. van Galen, Mikkel Brabrand, Tim Cooksley, Peter M. van de Ven, Hanneke Merten, Ralph K. L. So, Loes van Hooff, Harm R. Haak, Rachel M. Kidney, Christian H. Nickel, John T. Y. Soong, Immo Weichert, Mark H. H. Kramer, Christian P. Subbe, Prabath W. B. Nanayakkara*, Safer Home Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

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 Outcome(s) and Measure(s) (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.

Original languageEnglish
Pages (from-to)958-969
Number of pages12
JournalBMJ Quality & Safety
Volume26
Issue number12
DOIs
Publication statusPublished - Dec 2017

Keywords

  • CARE TRANSITIONS MEASURE
  • MEDICAL PATIENTS
  • DISCHARGE
  • QUALITY
  • VALIDATION
  • PREDICTION
  • REHOSPITALIZATION
  • DISADVANTAGE
  • PREPAREDNESS
  • INDICATOR

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