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Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews.

ABSTRACT: To gather qualitative data to elucidate the reasons for readmissions in a high-risk population of underserved patients.We created an instrument with 27 open-ended questions based on current interventions.Yale-New Haven Hospital.Patients at the Yale Adult Primary Care Center (PCC).We conducted semi-structured qualitative interviews of patients who had four or more admissions in the previous 6 months and were currently readmitted to the hospital.We completed 17 interviews and identified themes relating to risk of readmission. We found that patients went directly to the emergency department (ED) when they experienced a change in health status without contacting their primary provider. Reasons for this included poor telephone or urgent care access and the belief that the PCC could not treat acute illness. Many patients could not name their primary provider. Conversely, every patient except one reported being able to obtain medications without undue financial burden, and every patient reported receiving adequate home care services.These high-risk patients were receiving the formal services that they needed, but were making the decision to go to the ED because of inadequate access to care and fragmented primary care relationships. Formal transitional care services are unlikely to be adequate in reducing readmissions without also addressing primary care access and continuity.

SUBMITTER: Long T

PROVIDER: S-EPMC3780332 | biostudies-literature | 2013 Sep

REPOSITORIES: biostudies-literature

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Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews.

Long Theodore T Genao Inginia I Horwitz Leora I LI

BMJ open 20130919 9

<h4>Objective</h4>To gather qualitative data to elucidate the reasons for readmissions in a high-risk population of underserved patients.<h4>Design</h4>We created an instrument with 27 open-ended questions based on current interventions.<h4>Setting</h4>Yale-New Haven Hospital.<h4>Patients</h4>Patients at the Yale Adult Primary Care Center (PCC).<h4>Measurements</h4>We conducted semi-structured qualitative interviews of patients who had four or more admissions in the previous 6 months and were cu ...[more]

PMID: 24056478

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Project description:BackgroundHeart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient's experience may reframe the readmission "problem" and, ultimately, inform alternative strategies.ObjectiveTo understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission.DesignObservational qualitative study.ParticipantsHeart failure patients were recruited from two hospitals and included those who were hospitalized for heart failure at least twice within 30 days and those who had been recently discharged after their first heart failure admission.ApproachOpen-ended, semi-structured interviews. Conclusions vetted using focus groups.Key resultsSemi-structured interviews with 31 patients revealed a combination of physical and socio-emotional influences on patients' home heart failure management. Major themes identified were home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. Patients identified uncertainty regarding recommendations, caused by unclear instructions and temporal incongruence between behavior and symptom onset. This uncertainty impaired their competence in making routine management decisions, resulting in a cycle of limit testing and decreasing adherence. Patients reported experiencing hopelessness and frustration in response to perceiving a deteriorating functional status. This led some to a cycle of despair characterized by worsening adherence and negative emotions. As these cycles progressed and distressing symptoms worsened, patients viewed the hospital as the safest place for recovery and not a "negative" outcome.ConclusionCycles of limit testing and despair represent important patient-centered struggles in managing heart failure. The resulting distress and fear make readmission a rational choice for patients rather than a negative outcome. Interventions (e.g., palliative care) that focus on methods to address these patient-centered factors should be further studied rather than methods to reduce hospital readmissions.

Project description:OBJECTIVE:To assess how well the LACE index and its constituent elements predict 30-day hospital readmission, and to determine whether other combinations of clinical or sociodemographic variables may enhance prognostic capability. DESIGN:Retrospective cohort study with split sample design for model validation. SETTING:One large hospital Trust in the West Midlands. PARTICIPANTS:All alive-discharge adult inpatient episodes between 1 January 2013 and 31 December 2014. DATA SOURCES:Anonymised data for each inpatient episode were obtained from the hospital information system. These included age at index admission, gender, ethnicity, admission/discharge date, length of stay, treatment specialty, admission type and source, discharge destination, comorbidities, number of accident and emergency (A&E) visits in the 6?months before the index admission and whether a patient was readmitted within 30 days of index discharge. OUTCOME MEASURES:Clinical and patient characteristics of readmission versus non-readmission episodes, proportion of readmission episodes at each LACE score, regression modelling of variables associated with readmission to assess the effectiveness of LACE and other variable combinations to predict 30-day readmission. RESULTS:The training cohort included data on 91?922 patient episodes. Increasing LACE score and each of its individual components were independent predictors of readmission (area under the receiver operating characteristic curve (AUC) 0.773; 95%?CI 0.768 to 0.779 for LACE; AUC 0.806; 95%?CI 0.801 to 0.812 for the four LACE components). A LACE score of 11 was most effective at distinguishing between higher and lower risk patients. However, only 25% of readmission episodes occurred in the higher scoring group. A model combining A&E visits and hospital episodes per patient in the previous year was more effective at predicting readmission (AUC 0.815; 95%?CI 0.810 to 0.819). CONCLUSIONS:Although LACE shows good discriminatory power in statistical terms, it may have little added value over and above clinical judgement in predicting a patient's risk of hospital readmission.

Project description:BackgroundAlthough the workers in many occupations are at the greatest risk of catching and spreading COVID-19 due to assembling and contacting people, the owners of these occupations do not follow COVID-19 health instructions. The purpose of this study is to explain the reasons for not maintaining health guidelines to prevent COVID-19 in high-risk jobs in Iran.MethodsThe present study was conducted with a qualitative approach among people with high-risk jobs in Tehran during March and April of 2020. Data were collected through semi-structured interviews with 31 people with high-risk occupations selected by purposeful sampling and snowballing. The data were analyzed using the conventional qualitative content analysis method and MAXQDA-18 software. Guba and Lincoln's criteria were also used to evaluate the quality of the research results.Results4 main categories and 13 sub-categories were obtained, including individual factors (personality traits, lack of self-efficacy, little knowledge of the disease and how to observe health norms related to it, misconceptions about health), structural factors (difficulty of access to health supplies, lack of supportive environment, weak laws and supervision, the poor performance of officials and national media), economic factors (economic costs of living, lack of government economic support), Socio-cultural factors (learning, cultural beliefs, social customs, and rituals).ConclusionCOVID-19 prevention requires intervention at different levels. At the individual level: increasing people's awareness and understanding about how to prevent COVID-19 and strengthening self-efficacy in observing health norms, at the social level: highlighting positive patterns of observing health issues and training people about the consequences of social interactions during the outbreak of the virus, and at the macro level: strengthening regulatory rules and increasing people's access to hygienic products and support for the vulnerable must be taken into account.

Dataset Information

Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews.

Publications

Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews.

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