Background: In 2016, the Centers for Medicare & Medicaid Services (CMS) released a guide to preventing readmissions among diverse patient populations. According to CMS, once the health system effectively picks up the root causes and characteristics that are linked to readmissions – then a process can be initiated that focuses on addressing barriers and developing the systems to prevent them. Studies have shown that improvement of patient satisfaction and provision of patient-centered information at discharge lower 30-day risk for readmission after adjusting for clinical quality. Our study aims to identify differences in the patient-centered views of cause and preventability of readmission, between underrepresented Hispanic patients and other patient populations, to provide a more comprehensive understanding of patient perspectives and readmission preventability.
Methods: The study was conducted at the UCLA Medical Center. Readmissions data was obtained via a daily readmissions report for the general medicine service line. Patients with unplanned 30-day readmissions were eligible for enrollment in our study and were approached within 48 hours of their re-hospitalization. Prior to interviewing, patients were screened for exclusion criteria: patient unwilling to participate, patient re-hospitalized to the solid oncology or BMT service, or patient placed under droplet or airborne precautions. All remaining patients were approached and assessed for willingness and ability to participate. Continuous variables were compared using the student t-test. Categorical variables were compared using chi-squared analysis.
Results: 194 readmitted patients were successfully interviewed. Of those, 53 patients self-identified as Hispanic (27.3%) and 141 patients self-identified as Non-Hispanic (72.7%). Mean age (SD) was 53.9 (17.9) and 64.4 (18.2) (P = <0.001) for Hispanic and Non-Hispanic patients, respectively. Length of stay was higher for Hispanic patients, 7.5 (8.1) vs. 5.6 (5.0) (P = 0.054). Less Hispanic patients stated they had a PCP or main doctor that they felt comfortable if they started to feel worse at home 81.1% vs. 91.5% (P = 0.076). Moreover, less Hispanic patients felt ready for discharge from the hospital the first time they were discharged, 66% vs. 79.4% (P =0.1) and if the symptoms that brought them to the hospital the first time were improved enough that they could leave the hospital the first time, 62.3% vs. 75.9% (P = 0.040). Hispanic patients rated themselves at a higher risk for future readmission (P = 0.016). Taken together, it was found that the subsequent 30-day readmission rate for Hispanic and Non-Hispanic readmitted patients approached statistical significance, 39.5% vs. 24.2% (P = 0.066), respectively.
Conclusions: Current study results indicate that longer readmission hospital times and increased rates of readmission are linked to inadequate symptom management during initial hospitalization and insufficient follow-up with primary care physicians. These phenomena highlight the need for increased communication between the overseeing medical team, the patient, and the patient’s outside support system during recovery for appropriate discharge. Additionally, to address the tendency toward Hispanic patients perceiving that they would be rehospitalized, the medical team should address patient health literacy to equip discharged patients and family members or caretakers with the knowledge necessary to maintain autonomy outside of the hospital environment.