Reducing preventable hospital readmissions is a complex and challenging goal without a clear roadmap for successful attainment. The problem is compounded by the lack of consensus on the defining criteria for preventable readmissions. We sought to define a comprehensive conceptual model that classified the etiologic subtypes of readmissions by incorporating the perspectives of patients, family, and the full spectrum of providers.
We formed an interdisciplinary research team (physicians, nurses, researchers, and nonmedical staff) and used qualitative research methods based on grounded theory to conduct semistructured interviews and focus groups with readmitted patients and their “care circle” (families, hospital and home nurses, inpatient and outpatient physicians, and hospital social workers). These were conducted and audiotaped by members of the research team not directly involved with the patients’ care. Responses were iteratively reviewed and coded to design a conceptual model detailing possible causes for readmission. To enhance validity, we triangulated findings using the overlapping perspectives of subjects and researchers to arrive at a comprehensive set of themes associated with readmission to a hospital.
We identified five primary categories depicted in the conceptual model below. These categories were identified as mechanisms through which the care circle could be disrupted, potentially increasing the risk of readmission.
Readmissions are multifactorial, but preventability remains poorly defined. Our conceptual model provides a comprehensive set of categories that contributes to readmission based on the perspectives of the complete care circle. Our next step is to assess the preventability of these issues, so that efforts to reduce readmissions can focus on these components as well as strengthen the linkages in the care circle.