Factors Contributing to All-cause 30-day Readmissions

A Structured Case Series Across 18 Hospitals

Datos Bibliográficos

ID9102017
AutoresPaul Feigenbaum (0000-0001-9234-967X, Colorado Permanente Medical Group, autor de correspondencia), Estee Neuwirth (Kaiser Permanente), Linda Trowbridge (Kaiser Foundation Hospital), Serge Teplitsky (Kaiser Foundation Hospital), Carol A Barnes (0000-0001-8122-9007, Kaiser Permanente), Emily Fireman (Kaiser Permanente), Jann Dorman (Kaiser Permanente), Jim Bellows (Kaiser Permanente)
Año2012
Volumen50
Número7
Páginas599-605
Fecha de publicación2012-07-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e318249ce72
PMID22354212
OpenAlexW2333064195
IdiomaEN
Citas recibidas6
Referencias citadas32

OBJECTIVE: To understand factors leading to all-cause 30-day readmissions in a community hospital population. RESEARCH DESIGN: Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team. SETTING: Eighteen Kaiser Permanente Northern California hospitals. RESULTS: Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management. CONCLUSIONS: Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified

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