title: Early readmission among patients with diabetes: a qualitative assessment of contributing factors.
abstract: OBJECTIVE
  To explore causes of early readmission, i.e., hospital readmission within 30 days of discharge, among patients with diabetes.
  
  
  METHODS
  We performed thematic analysis of semi-structured interviews among 20 adults with diabetes hospitalized with an early readmission at an urban academic medical center.
  
  
  RESULTS
  Five themes emerged as contributors to readmission risk: (1) poor health literacy (lack of knowledge about diabetes and discharge instructions), (2) health system failure (of the discharge process and post-discharge support), (3) failure of expected protective factors, (e.g., following the discharge instructions, being aware of medication changes upon discharge, and having help and social support), (4) social determinants of health impeding care, and (5) loss of control over illness. A majority of patients reported needing assistance with transportation, obtaining and taking medications, and preparing food. Most patients denied an active role in exacerbating their condition prior to readmission, and many believed that being readmitted was out of their control.
  
  
  CONCLUSIONS
  Our findings suggest several interventions that may reduce the risk of early readmission for patients with diabetes, including inpatient diabetes education, improving communication of discharge instructions, and involving patients more in medication reconciliation and post-discharge planning.
authors.affiliation: Temple University School of Medicine, Section of Endocrinology, Diabetes, and Metabolism. Electronic address: djrubin@temple.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Rubin
authors.affiliation: Temple University School of Medicine, Section of Endocrinology, Diabetes, and Metabolism.
authors.forename: Kelly
authors.initials: K
authors.lastname: Donnell-Jackson
authors.affiliation: Temple University School of Medicine, Section of Endocrinology, Diabetes, and Metabolism.
authors.forename: Ram
authors.initials: R
authors.lastname: Jhingan
authors.affiliation: Inpatient Diabetes Management Program, Division of Endocrinology, Diabetes, and Metabolism; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine.
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
authors.affiliation: Temple University School of Medicine, Section of General Internal Medicine.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Paranjape
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D064890:Social Determinants of Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: Diabetes mellitus; Hospital discharge; Qualitative methodology; Readmissions; Thematic analysis