Patient-Reported Discharge Readiness and 30-Day Risk of Readmission or Death: A Prospective Cohort Study.
BACKGROUND
Early readmissions to hospital after discharge are common, and clinicians cannot accurately predict their occurrence. We examined whether patients who feel unready at the time of discharge have increased readmissions or death within 30 days.


METHODS
This was a prospective cohort study of adult patients discharged home from 2 tertiary care hospitals in Edmonton, Alberta, Canada, between October 2013 and November 2014. Patient-reported discharge readiness was measured with an 11-point Likert response scale, with scores <7 indicating subjective unreadiness. The primary outcome was readmission or death within 30 days. Logistic regression models were adjusted for age, sex, and a validated risk prediction score for postdischarge events (LACE index).


RESULTS
Of 495 patients (mean age 62 years, 51% female, mean Charlson comorbidity index 2.8), 112 (23%) reported being unready for discharge. Risk factors for being unready at discharge were cognitive impairment (mild vs none), low satisfaction with health care services, depression, lower education, previous hospital admissions (12 months), and persistent symptoms or disability. At 30 days, 85 patients (17%) had been readmitted or died, with no significant difference between patients who felt unready or ready (15% vs 18%, adjusted odds ratio 0.84, 95% confidence interval 0.46-1.54, P = .59).


CONCLUSIONS
Although nearly one-quarter of hospitalized medical patients reported being unready at the time of discharge, they did not experience any higher risk of readmission or death in the first 30 days after discharge, compared with patients who felt ready for discharge.
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Darren
D
Lau
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Raj S
RS
Padwal
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Sumit R
SR
Majumdar
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Jenelle L
JL
Pederson
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Sara
S
Belga
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Sharry
S
Kahlon
Epidemiology Coordinating and Research Centre (EPICORE), University of Alberta, Edmonton, Alberta, Canada.
Miriam
M
Fradette
Epidemiology Coordinating and Research Centre (EPICORE), University of Alberta, Edmonton, Alberta, Canada.
Debbie
D
Boyko
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada; Patient Health Outcomes Research and Clinical Effectiveness Unit (PHORCE), University of Alberta, Edmonton, Alberta, Canada. Electronic address: finlay.mcalister@ualberta.ca.
Finlay A
FA
McAlister
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003072:Cognition Disorders / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors
General internal medicine; Health services research; Patient satisfaction; Patient-reported outcomes; Readmissions