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A Qualitative Study Identifying the Potential Risk Mechanisms Leading to Hospitalization for Patients With Chronic
Gary E Weissman1, Jasmine A Silvestri2, Folasade Lapite3
1Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Understanding the root causes of chronic lung disease hospitalizations is key. Interventions must target specific patient mechanisms like limited home management capacity and access barriers, not just risk factors, to reduce readmissions.
Area of Science:
- Pulmonary Medicine
- Health Services Research
- Qualitative Research
Background:
- Care management programs for chronic lung disease aim to reduce hospitalizations but often fail.
- Existing programs target at-risk patients but not the underlying mechanisms driving hospitalizations.
Purpose of the Study:
- To identify common mechanisms linking patient risk factors to hospitalizations for acute exacerbations of chronic lung disease.
Main Methods:
- Qualitative study involving 69 interviews with patients, caregivers, and clinicians.
- Interviews focused on hospitalizations for acute exacerbations of chronic lung disease.
- Triangulation and abductive analysis of interview transcripts.
Main Results:
- Identified mechanisms including limited home management capacity, access to care barriers, functional limitations, and behavioral health disorders.
- These mechanisms were present for months or years prior to the acute exacerbation.
- Hospitalization risk is driven by specific clinical, social, and behavioral factors.
Conclusions:
- Care management programs should target specific, underlying mechanisms of hospitalization.
- Interventions addressing these upstream factors can reduce hospitalization risk for chronic lung disease patients.
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