title: Understanding patient-centred readmission factors: a multi-site, mixed-methods study.
abstract: Patient concerns at or before discharge inform many transitional care interventions; few studies examine patients' perceptions of self-care and other factors related to readmission.
  
  
  
  To characterise patient-reported or caregiver-reported factors contributing to readmission.
  
  
  
  Cross-sectional, national study of general medicine patients readmitted within 30 days at 12 US hospitals. Interviews included multiple-choice survey and open-ended survey questions of patients or their caregivers.
  
  
  
  Multiple-choice survey quantified post-discharge difficulty in seven domains of self-care: medication use, contacting providers, transportation, basic needs (eg, food and shelter), diet, social support and substance abuse. Open-ended responses were coded into themes that added depth to the domains above or captured additional patient-centred concerns.
  
  
  
  We interviewed 1066 readmitted patients. 91% reported understanding their discharge plan; however, only 37% reported that providers asked about barriers to carrying out the plan. 52% reported experiencing difficulty in ≥1 self-care domains ranging in frequency from 22% (diet) to 7% (substance use); 26% experienced difficulty in two or more domains. Among 508 patients (48% overall) who reported no difficulties in these domains, two-thirds either could not attribute their readmission to any specific difficulty (34%) or attributed their readmission to progression or persistence of their disease despite following their discharge plan (31%). Only 20% attributed their readmission to early discharge (8%), poor-quality hospital care (6%) or issues such as inadequate discharge instructions or follow-up care (6%).
  
  
  
  The study population included only patients readmitted at academic medical centres and may not be representative of community-based care.
  
  
  
  Patients readmitted within 30 days reported understanding their discharge plans, but frequent difficulties in self-care and low anticipatory guidance for resolving these issues after discharge.
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, CA, USA.
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, CA, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Harrison
authors.affiliation: Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vasilevskis
authors.affiliation: Christiana Heath Care System, Wilmington, DE, USA.
authors.forename: Edmondo
authors.initials: E
authors.lastname: Robinson
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Metlay
authors.affiliation: Division of General Internal Medicine, Brigham and Womens Hospital, Boston, MA, USA.
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Schnipper
authors.affiliation: Section of Hospital Medicine, University of Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Meltzer
authors.affiliation: School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Sehgal
authors.affiliation: Section of Hospital Medicine, University of Chicago, IL, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Ruhnke
authors.affiliation: Division of Hospital Medicine, University of Kentucky, Louisville, KY, USA.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, CA, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012648:Self Care; D012944:Social Support; D014481:United States; D055815:Young Adult
keywords: Health policy; Health services research; Hospital medicine; Patient-centred care; Qualitative research