title: Patient-identified factors related to heart failure readmissions.
abstract: BACKGROUND
  Although readmission after hospitalization for heart failure has received increasing attention, little is known about its root causes. Prior investigations have relied on administrative databases, chart review, and single-question surveys.
  
  
  RESULTS
  We performed semistructured 30- to 60-minute interviews of patients (n=28) readmitted within 6 months of index heart failure admission. Established qualitative approaches were used to analyze and to interpret data. Interview findings were the primary focus of the study, but patient information and provider comments from chart data were also consulted. Patient median age was 61 years; 29% were nonwhite; 50% were married; 32% had preserved ejection fraction; and median time from discharge to readmission was 31 days. Reasons for readmission were multifactorial and not easily categorized into mutually exclusive reasons. Five themes emerged as reasons cited for hospital readmission: distressing symptoms, unavoidable progression of illness, influence of psychosocial factors, good but imperfect self-care adherence, and health system failures.
  
  
  CONCLUSIONS
  Our study provides the first systematic qualitative assessment of patient perspectives concerning heart failure readmission. Contrary to prior literature and distinct from what we found documented in the medical record, patient experiences were highly heterogeneous, not easily categorized as preventable or not preventable, and not easily attributed to a single cause. These findings suggest that future interventions designed to reduce heart failure readmissions should be multifaceted, should be systemic in nature, and should integrate patient input.
authors: School of Public Affairs, Department of Health and Behavioral Sciences, University of Colorado-Denver, CO, USA. Jessica.Retrum@ucdenver.edu
authors: Jessica H
authors: JH
authors: Retrum
authors: Jennifer
authors: J
authors: Boggs
authors: Andrew
authors: A
authors: Hersh
authors: Leslie
authors: L
authors: Wright
authors: Deborah S
authors: DS
authors: Main
authors: David J
authors: DJ
authors: Magid
authors: Larry A
authors: LA
authors: Allen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado; D019033:Delivery of Health Care, Integrated; D018450:Disease Progression; D005260:Female; D006302:Health Services Research; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006764:Hospitals, Community; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010359:Patient Readmission; D018802:Patient-Centered Care; D011379:Prognosis; D036301:Qualitative Research; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D012959:Socioeconomic Factors; D013997:Time Factors
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