We consult experts. We consult data. We consult evidence.
But in our quest to reduce 30-day readmissions, are we overlooking a key source of insight?
A group of researchers recently thought so and aimed to rectify that. They consulted patients themselves — in the midst of their 30-day readmissions — on what they believed landed them back in the hospital.
“If we want to get to the bottom of why they come back to the hospital, we thought, ‘Why don’t we ask them?’” said study coauthor Greg Misky, MD, a hospitalist at UC Health University of Colorado Hospital.
Their investigation, slated for publication in an upcoming issue of the Journal for Healthcare Quality, consisted of bedside interviews with 18 patients readmitted within 30 days of their previous discharge. Two patients were uninsured, and 16 patients were covered by Medicaid. All had stories behind their readmissions.
Professional research assistants talked with them at the bedside to find out what happened during their previous hospitalization, what happened at home after discharge, what led to their readmission, what might have prevented it, and what their healthcare experiences outside the hospital consisted of.
Researchers identified five themes that contributed to these patients’ 30-day readmissions. They reveal some unique factors that shed light on their situations outside hospital walls.
Therapeutic misalignment is a fancy way of saying that patients expressed “compromised trust in their providers, care team and health system,” researchers explained, “often related to imperfect communication.”
Consider these words, directly from the patients’ mouths:
Some patients made bad decisions and lacked accountability for managing their health. They were blunt about using alcohol, ignoring medical advice, and not knowing or bothering to ask for reasons to take their medications.
3. SOCIAL FRAGILITY
“They often have competing priorities,” explained Dr. Misky.
Holding onto jobs and providing for their family’s basic needs were common concerns among patients. For many, their living conditions made it difficult to manage chronic diseases like diabetes, COPD, or heart failure.
4. ACCESS FAILURES
Poor access to primary care, a lack of transportation, and difficulties with basic health literacy were common among readmitted patients.
5. DISEASE BEHAVIOR
The progression of disease after discharge was another factor that landed patients back in the hospital.
LESSENING THE LIKELYHOOD OF FAILURE
The researchers concluded that unstable social situations and, frankly, health system failures played major roles in the 30-day readmissions of the patients interviewed. Expanded case management and care coordination better aligned to the needs of the population is necessary, Dr. Misky said.
Healthcare providers, he added, also need to make more of an effort to tune into patients’ realities if the situation is ever to improve.
“As providers, we live in a different world than these patients,” Dr. Misky said. “Unless we walk in their shoes, we can’t envision how hard it is for them to succeed.”
Strengthening trust between healthcare providers and patients is essential, according to the authors, as is encouraging patients to participate in healthcare decisions.
“Their words are telling us where the problems are,” Dr. Misky said. “We need to lessen the likelihood that patients fail.”
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