Background:
Readmission rates are an increasingly important indicator of quality hospital care. Understanding the characteristics of readmissions may help to reduce unnecessary readmissions. We evaluated characteristics of readmissions to our general medicine service and reviewed case management readmission assessments in order to inform efforts to improve the discharge process and reduce avoidable readmissions.
Methods:
We retrospectively reviewed 6 months of readmission data for the general medical service and conducted a focus group of the care coordinators. We analyzed readmission rates, number of days from discharge, payer status, and length of stay. Case managers assessed the reason for each readmission and whether that readmission was avoidable. The focus group posed questions related to readmission characteristics and potential interventions.
Results:
Seventeen percent of general medicine patients were readmitted within 30 days. Of the 429 readmissions to the medicine service, 26% were originally admitted to a different service. Nearly half the patients were covered by Medicare, 25% were covered by Medi‐Cal or Medicaid, 23% were covered by private insurance. Forty‐five percent were readmitted within 10 days of discharge. There was no difference in payer status between those readmitted within 10 days of discharge and those readmitted more than 10 days after discharge. Average length of stay (± SD) for initial admission was similar for patients readmitted within 10 days (7.8 ± 13 days) and patients readmitted after more than 10 days (7.1 ± 14 days; P = .56). The most common reasons for readmission were failed outpatient treatment (25%), new diagnosis (23%), and normal progression of disease (16%). Case managers categorized only 2% of readmissions as avoidable. From the focus group, several key contributors to readmissions were identified: a culture of dependency on inpatient care, patients' skepticism about outpatient management, and the hospital as a surrogate caretaker for those with limited social support. Strategies for decreasing readmissions focused on increasing patient autonomy, improving outpatient chronic disease management, and bridging care with the county hospital.
Conclusions:
This study identified baseline characteristics of medicine readmissions. Case management assessments revealed several areas for potential interventions to reduce readmission rates. These initial findings will inform our future research, which will analyze readmis‐sions using a multidisciplinary prospective approach.
Author Disclosure:
N. Allaudeen, none; A. Vidyarthi, none.