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Patients' Perspectives on Reasons for Unplanned Readmissions
Amy M LeClair1, Megan Sweeney, Grace H Yoon
1Amy M. LeClair, PhD, is a Health Services Researcher and Assistant Professor at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA. She is a medical sociologist who uses qualitative and mixed methods to health services research with disadvantaged populations. Megan Sweeney, BS, is a current first-year medical student at Western University of Health Sciences, Pomona, CA. Until 2017, she served as the Executive Assistant to Dr. Saul Weingart, the Chief Medical Officer in the Office of Quality Improvement at Tufts Medical Center. Grace H. Yoon, BA, is a Research Assistant at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA. Jana C. Leary, MD, is a pediatrician at Tufts Medical Center and a current post-doctoral fellow at the Sackler School of Graduate Biomedical Sciences, Boston, MA. Her current research focuses on predictors of readmission in the pediatric and medically complex populations. Saul N. Weingart, MD, MPP, PhD, is a Primary Care Physician and the Chief Medical Officer at Tufts Medical Center, Boston, MA. He is a nationally renowned leader in the movement to improve hospital quality and oversees numerous quality improvement projects at the Medical Center. Karen M. Freund, MD, MPH, is a Primary Care Physician and the Vice Chair of Quality Improvement and Faculty Affairs at Tufts Medical Center, Boston, MA. She oversees research projects at the Institute for Clinical Research and Health Policy Studies as the Program Director.
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Massachusetts has one of the highest rates of 30-day readmissions in the country. To identify patient-reported factors that may contribute to readmissions, we conducted semi-structured interviews with patients with unplanned readmissions within 30 days of inpatient discharge from the medicine services at an urban medical center between June and August 2016. Interviews with patients and/or proxies were conducted in English, Spanish, Mandarin, or Cantonese, then translated to English if necessary, transcribed verbatim, and deidentified. A team of four coders conducted the thematic analysis. Most patients did not identify factors associated with readmission beyond their underlying illness; however, a mismatch between the patient's clinical care needs and services available at postacute facilities, as well as poor communication between providers, facilities, and patients/proxies, were identified as contributing factors to readmissions. Non-English speaking patients and their families reported confusion with written discharge instructions, even if an interpreter provided verbal instructions. Patients will benefit from future interventions that aim to improve transfers to postacute care facilities, develop written materials in languages prevalent in the local population, and improve communication among providers, facilities, and patients and their families.