title: Identification of process measures to reduce postoperative readmission.
abstract: BACKGROUND
  Readmission rates after intestinal surgery have been notably high, ranging from 10 % for elective surgery to 21 % for urgent/emergent surgery. Other than adherence to established strategies for decreasing individual postoperative complications, there is little guidance available for providers to work toward reducing their postoperative readmission rates.
  
  
  METHODS
  Processes of care that may affect postoperative readmissions were identified through a systematic literature review, assessment of existing guidelines, and semi-structured interviews with individuals who have expertise in hospital readmissions and surgical quality improvement. Eleven experts ranked potential process measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology.
  
  
  RESULTS
  Of 49 proposed process measures, 34 (69 %) were rated as valid. Of the 34 valid measures, two measures addressed care in the preoperative period. These included evaluation of patient's comorbidities, providing written instruction detailing the anticipated perioperative course, and communication with the patient's referring or primary care doctor. A measure addressing perioperative care stated that institutions should have a standardized perioperative care protocol. Additional measures focused on discharge instructions and communication.
  
  
  CONCLUSIONS
  An expert panel identified several aspects of care that are considered essential to quality patient care and important to reducing postoperative readmissions.
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, Suite 650, Chicago, IL, 60611, USA, ahalverson@nmff.org.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Halverson
authors.forename: Morgan M
authors.initials: MM
authors.lastname: Sellers
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
mesh_terms: D003697:Delphi Technique; D006801:Humans; D007407:Interviews as Topic; D007422:Intestines / Q000601:surgery*; D010359:Patient Readmission; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D017064:Process Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care