title: Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals.
abstract: OBJECTIVE
  To understand factors leading to all-cause 30-day readmissions in a community hospital population.
  
  
  METHODS
  Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team.
  
  
  METHODS
  Eighteen Kaiser Permanente Northern California hospitals.
  
  
  RESULTS
  Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management.
  
  
  CONCLUSIONS
  Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified.
authors.affiliation: The Permanente Medical Group, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Feigenbaum
authors.forename: Estee
authors.initials: E
authors.lastname: Neuwirth
authors.forename: Linda
authors.initials: L
authors.lastname: Trowbridge
authors.forename: Serge
authors.initials: S
authors.lastname: Teplitsky
authors.forename: Carol Ann
authors.initials: CA
authors.lastname: Barnes
authors.forename: Emily
authors.initials: E
authors.lastname: Fireman
authors.forename: Jann
authors.initials: J
authors.lastname: Dorman
authors.forename: Jim
authors.initials: J
authors.lastname: Bellows
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data