Understanding patient-centred readmission factors: a multi-site, mixed-methods study.

Area of Science:

• Healthcare research
• Patient outcomes
• Transitional care

Background:

• Patient concerns are crucial for transitional care interventions.
• Limited research exists on patient perceptions of self-care and readmission factors.

Purpose of the Study:

• To characterize patient- or caregiver-reported factors contributing to hospital readmission.
• To identify self-care challenges faced by readmitted patients.

Main Methods:

• Cross-sectional national study involving 1066 readmitted general medicine patients across 12 US hospitals.
• Interviews included multiple-choice and open-ended survey questions.
• Quantified post-discharge difficulties in seven self-care domains (medication, provider contact, transportation, basic needs, diet, social support, substance abuse).

Main Results:

• 91% understood discharge plans, but only 37% reported providers discussed barriers.
• 52% experienced difficulties in at least one self-care domain; 26% in two or more.
• Among those reporting no difficulties, many attributed readmission to disease progression or inability to identify specific barriers.

Conclusions:

• Readmitted patients understand discharge plans but face significant self-care challenges.
• There is a need for better anticipatory guidance and support for post-discharge self-care.
• Transitional care interventions should address identified patient-reported barriers to reduce readmissions.