ABSTRACT
BACKGROUND: Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital-based clinicians with limited evidence on how to reduce SNF readmissions. OBJECTIVE: To understand the perspectives of clinicians working at SNFs regarding factors contributing to readmissions. DESIGN AND PARTICIPANTS: We prospectively identified consecutive readmissions from SNFs to a single tertiary-care hospital. Index admissions and readmissions were to the hospital's inpatient general medicine service. SNF clinicians who cared for the readmitted patients were identified and interviewed about root causes of the readmissions using a structured interview tool. Transcripts of the interviews were inductively analyzed using grounded theory methodology. RESULTS: RESULTS: We interviewed 28 clinicians at 15 SNFs. The interviews covered 24 patient readmissions. SNF clinicians described a range of procedural, technological, and cultural contributors to unplanned readmissions. Commonly cited causes of readmission included a lack of coordination between emergency departments and SNFs, poorly defined goals of care at the time of hospital discharge, acute illness at the time of hospital discharge, limited information sharing between a SNF and hospital, and SNF process and cultural factors. CONCLUSIONS: SNF clinicians identified a broad range of factors that contribute to readmissions. Addressing these factors may mitigate patients' risk of readmission from SNFs to acute care hospitals.
Subject(s)
Patient Care Team/organization & administration , Patient Readmission/statistics & numerical data , Perception , Skilled Nursing Facilities/organization & administration , Aged , Female , Grounded Theory , Humans , Interviews as Topic , Male , Patient Discharge , Patient Transfer/statistics & numerical data , Prospective Studies , Qualitative Research , Quality ImprovementABSTRACT
This article discusses how community-based participatory research (CBPR) on hospital care transitions in New Haven, Connecticut led to the development of a new medical respite program to better serve patients who are homeless. Key insights include: ⢠Homelessness is an important driver of hospital utilization and must be addressed in efforts to decrease hospital readmissions. ⢠Hospitals and community organizations often serve a shared patient/client base and can work together to develop innovative programs that are beneficial to all parties. ⢠Community-based participatory research methods are particularly conducive to producing research that is translatable to policy and new programs. ⢠Targeted dissemination of research results played a pivotal role in securing resources and funding for the new program.
