title: Readmissions at a public safety net hospital.
abstract: OBJECTIVE
  We aimed to determine factors related to avoidability of 30-day readmissions at our public, safety net hospital in the United States (US).
  
  
  METHODS
  We prospectively reviewed medical records of adult internal medicine patients with scheduled and unscheduled 30-day readmissions. We also interviewed patients if they were available. An independent panel used pre-specified, objective criteria to adjudicate potential avoidability.
  
  
  RESULTS
  Of 153 readmissions evaluated, 68% were unscheduled. Among these, 67% were unavoidable, primarily due to disease progression and development of new diagnoses. Scheduled readmissions accounted for 32% of readmissions and most (69%) were clinically appropriate and unavoidable. The scheduled but avoidable readmissions (31%) were attributed largely to limited resources in our healthcare system.
  
  
  CONCLUSIONS
  Most readmissions at our public, safety net hospital were unavoidable, even among our unscheduled readmissions. Surprisingly, one-third of our overall readmissions were scheduled, the majority reflecting appropriate management strategies designed to reduce unnecessary hospital days. The scheduled but avoidable readmissions were due to constrained access to non-emergent, expensive procedures that are typically not reimbursed given our system's payor mix, a problem which likely plague other safety net systems. These findings suggest that readmissions do not necessarily reflect inadequate medical care, may reflect resource constraints that are unlikely to be addressable in systems caring for a large burden of uninsured patients, and merit individualized review.
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America; Department of Medicine, Hawaii Permanente Medical Group, Wailuku, Hawaii, United States of America; Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America.
authors.forename: Eri
authors.initials: E
authors.lastname: Shimizu
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America; David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Glaspy
authors.affiliation: David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America; Division of HIV Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.affiliation: Department of Medicine, Maui Memorial Medical Center, Wailuku, Hawaii, United States of America.
authors.forename: Kimble
authors.initials: K
authors.lastname: Poon
authors.affiliation: Department of Quality, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Black
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Shelley
authors.initials: S
authors.lastname: Schwartz
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Tasneem
authors.initials: T
authors.lastname: Bholat
authors.affiliation: Department of Quality, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Norma
authors.initials: N
authors.lastname: Diaz
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.
authors.forename: Allen
authors.initials: A
authors.lastname: Kuo
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America; David Geffen School of Medicine at University of California at Los Angeles (UCLA), Los Angeles, California, United States of America.
authors.forename: Brad
authors.initials: B
authors.lastname: Spellberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D064876:Safety-net Providers; D014481:United States