Andrew D. Auerbach|Sunil Kripalani|Eduard E. Vasilevskis|Neil Sehgal|Peter K. Lindenauer|Joshua P. Metlay|Grant Fletcher|Gregory Ruhnke|Scott A. Flanders|Christopher Kim|Mark Williams|Larissa R. Thomas|Vernon Giang|Shoshana J. Herzig|Kanan Patel|W. John Boscardin|Edmondo Robinson|Jeffrey L. Schnipper
Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients
University of California, San Francisco|Vanderbilt University|Vanderbilt University|University of California, San Francisco|Baystate Medical Center|Tufts University|Massachusetts General Hospital|Harborview Medical Center|University of Chicago|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Kentucky|San Francisco General Hospital|California Pacific Medical Center|Beth Israel Deaconess Medical Center|University of California, San Francisco|University of California, San Francisco|Christiana Care Health System|Brigham and Women's Hospital|Harvard University
readmission penalties catalyzed efforts improve care transitions programs incorporated viewpoints patients health care professionals determine readmission preventability prioritize opportunities care improvementto determine preventability readmissions use estimates prioritize areas improvementan observational study conducted 1000 general medicine patients readmitted within 30 days discharge 12 us academic medical centers april 1 2012 march 31 2013 surveyed patients physicians reviewed documentation performed 2physician case review determine preventability factors contributing readmission used bivariable statistics compare preventable nonpreventable readmissions multivariable models identify factors associated potential preventability baseline risk factor prevalence adjusted odds ratios aors determine proportion readmissions affected individual risk factorslikelihood readmission could preventedthe study cohort comprised 1000 patients median age 55 years 269 269 considered potentially preventable multivariable models factors strongly associated potential preventability included emergency department decision making regarding readmission aor 913 95 ci 5231595 failure relay important information outpatient health care professionals aor 419 95 ci 217809 discharge patients soon aor 388 95 ci 244617 lack discussions care goals among patients serious illnesses aor 384 95 ci 1391064 common factors associated potentially preventable readmissions included emergency department decision making affecting 90 95 ci 71103 inability keep appointments discharge affecting 83 95 ci 41120 premature discharge hospital affecting 87 95 ci 58113 patient lack awareness contact discharge affecting 62 95 ci 3587approximately onequarter readmissions potentially preventable assessed using multiple perspectives highpriority areas improvement efforts include improved communication among health care teams health care professionals patients greater attention patients readiness discharge enhanced disease monitoring better support patient selfmanagement