Background: Since the roll out of the Affordable Care Act in 2012 there has been an increased financial pressure to prevent 30-day hospital readmissions. Yet the readmissions rate has remained relatively unchanged despite myriad of health system interventions have been trialed. To approach this issue from a new perspective we decided to query the patient’s opinion of the readmission process and what factors they believe contributed to their re-hospitalization. We then contrasted this with health care providers opinions to get a fuller picture of where the system broke down.

Methods: This was an observational cross-sectional study of patients 18 years of age or older with an unplanned readmission within 30-days of discharge from Stanford Hospital. Patients were interviewed in-person during their readmission hospitalization by a nurse case manager. They were queried on their perspective of factors that contributed to their readmission. Providers that cared for the patient at time of discharge from the index hospitalization were also queried as to their opinions of what lead to the patients less than 30-day readmission. Finally, a chart review was performed by a nurse-case-manager to objectively identify what system or patient issues might have lead to readmission.

Results: We interviewed 182 readmitted patients along with 103 of their index admission providers. Our results found that 58% of patients felt that the hospital system could have done something different to prevent their readmission. This opinion correlated with patients also having a poor functional status and higher physical therapy needs (X2 p=0.03 and p=0.005, respectively).  Of the 58% of patients who felt underprepared for discharge, 36% of patients felt discharged too early and 24% desired more home or skilled nursing support. Meanwhile providers felt only 5% of the time the readmission was a systems related issue. However, on independent review by a nurse case-manager it was determined that 49% of the time the system could have better supported the patient.

Conclusions: Readmitted patients often feel that upon discharge that they have not been adequately supported by the hospital system. This is most likely to occur in settings where the patients have low functional status and high physical therapy needs. Interestingly, providers do not identify systems issues that contributed their patients’ readmission.  This study suggests that patient’s may have better insights into their own discharge needs than their providers.