Clinical question: Are patient perceptions of care during index hospitalization associated with likelihood of 30-day readmission?
Background: Hospital readmissions are costly (more than $40 billion annually) and common. Nearly one readmission in five is thought to be preventable. While many risk-prediction models exist, few incorporate patient perceptions during the index hospitalization or factors associated with patient experience.
Study design: Prospective cohort study.
Setting: Single-center academic medical center.
Synopsis: A total of 846 patients – admitted to one of two inpatient general medicine wards at Massachusetts General Hospital in Boston, and were English speaking, aged 18 years or older, and possessed the ability to complete a 20-item study questionnaire – were screened from January 2012 to January 2016. An interviewer-assisted questionnaire was coupled with structured medical records review. Among items assessed were demographic information, patient perceptions of health, satisfaction with inpatient care, confidence in ability to perform self-care and understanding of the care plan, presence of a caregiver, and patient-predicted likelihood of readmission. Of 846 enrolled patients, 201 were readmitted within 30 days. Readmitted patients were less likely to report being “very satisfied” with their overall care during the index admission, and less likely to report that physicians “always listened” to them during the index stay.
Bottom line: This is the first study to relate patients’ perceptions of their care during index hospitalization to the likelihood of readmission. Further investigation will be necessary to determine whether timely assessment of these perceptions can prompt effective intervention that improves likelihood of an enduringly successful transition home.
Citation: Carter J et al. The association between patient experience factors and likelihood of 30-day readmission: A prospective cohort study. BMJ Qual Saf. 2017 Nov 16. doi: 10.1136/bmjqs-2017-007184.
Dr. Helgerson is associate professor of medicine and section head, division of hospital medicine, University of Virginia.