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

doi:10.1136/bmjqs-2017-006645

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 journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	958-969
Number of pages	12
Journal	BMJ Quality & Safety
Volume	26
Issue number	12
DOIs	https://doi.org/10.1136/bmjqs-2017-006645
Publication status	Published - Dec 2017

Keywords

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

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10.1136/bmjqs-2017-006645

Cite this

van Galen, L. S., Brabrand, M., Cooksley, T., van de Ven, P. M., Merten, H., So, R. K. L., van Hooff, L., Haak, H. R., Kidney, R. M., Nickel, C. H., Soong, J. T. Y., Weichert, I., Kramer, M. H. H., Subbe, C. P., Nanayakkara, P. W. B., & Safer Home Consortium (2017). Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries. BMJ Quality & Safety, 26(12), 958-969. https://doi.org/10.1136/bmjqs-2017-006645

@article{528366dcf39344eaa3935420fc5db1e3,

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

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 countriesParticipants 1398 medical patients readmitted unscheduled within 30 daysMain 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.",

keywords = "CARE TRANSITIONS MEASURE, MEDICAL PATIENTS, DISCHARGE, QUALITY, VALIDATION, PREDICTION, REHOSPITALIZATION, DISADVANTAGE, PREPAREDNESS, INDICATOR",

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

year = "2017",

month = dec,

doi = "10.1136/bmjqs-2017-006645",

language = "English",

volume = "26",

pages = "958--969",

journal = "BMJ Quality & Safety",

issn = "2044-5415",

publisher = "BMJ Publishing Group",

number = "12",

}

van Galen, LS, Brabrand, M, Cooksley, T, van de Ven, PM, Merten, H, So, RKL, van Hooff, L, Haak, HR, Kidney, RM, Nickel, CH, Soong, JTY, Weichert, I, Kramer, MHH, Subbe, CP, Nanayakkara, PWB & Safer Home Consortium 2017, 'Patients' and providers' perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries', BMJ Quality & Safety, vol. 26, no. 12, pp. 958-969. https://doi.org/10.1136/bmjqs-2017-006645

TY - JOUR

T1 - Patients' and providers' perceptions of the preventability of hospital readmission

T2 - a prospective, observational study in four European countries

AU - van Galen, Louise S.

AU - Brabrand, Mikkel

AU - Cooksley, Tim

AU - van de Ven, Peter M.

AU - Merten, Hanneke

AU - So, Ralph K. L.

AU - van Hooff, Loes

AU - Haak, Harm R.

AU - Kidney, Rachel M.

AU - Nickel, Christian H.

AU - Soong, John T. Y.

AU - Weichert, Immo

AU - Kramer, Mark H. H.

AU - Subbe, Christian P.

AU - Nanayakkara, Prabath W. B.

AU - Safer Home Consortium

PY - 2017/12

Y1 - 2017/12

N2 - 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 countriesParticipants 1398 medical patients readmitted unscheduled within 30 daysMain 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.

AB - 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 countriesParticipants 1398 medical patients readmitted unscheduled within 30 daysMain 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.

KW - CARE TRANSITIONS MEASURE

KW - MEDICAL PATIENTS

KW - DISCHARGE

KW - QUALITY

KW - VALIDATION

KW - PREDICTION

KW - REHOSPITALIZATION

KW - DISADVANTAGE

KW - PREPAREDNESS

KW - INDICATOR

U2 - 10.1136/bmjqs-2017-006645

DO - 10.1136/bmjqs-2017-006645

M3 - Article

SN - 2044-5415

VL - 26

SP - 958

EP - 969

JO - BMJ Quality & Safety

JF - BMJ Quality & Safety

IS - 12

ER -