title: From discharge to readmission: Understanding the process from the patient perspective.
abstract: Patient engagement is critical in delivering high-quality care. However, literature investigating patient perspectives on readmissions is lacking.
  
  
  
  To understand patients' beliefs and attitudes about 30-day readmissions and to elucidate areas for improvement aimed at reducing readmissions.
  
  
  
  In person survey.
  
  
  
  Academic medical center and affiliated community hospital.
  
  
  
  Patients with 30-day readmissions to medicine and cardiology services.
  
  
  
  Patient readiness, attitudes toward readmissions, discharge instructions, ambulatory resources, and follow-up care.
  
  
  
  Of 479 eligible patients approached for interviews, 230 (48%) were interviewed. Of these, 28% reported not feeling ready for discharge, and this correlated with inadequate symptom resolution, poor pain control, and concerns about self-care. Sixty-five percent remembered reviewing discharge paperwork, but over 22% could not identify critical information on this paperwork. Eighty-five percent reported having a primary doctor; however, only 56% of patients who received a contact number on discharge called a physician before returning to the hospital. One-third of patients knew where to obtain same-day care outside of the emergency room. Lastly, patients reported feeling more relieved than burdened upon readmission (7.7 [standard deviation {SD} 2.8) vs 5.9 [SD 3.4]; P < 0.001, scale of 1-10).
  
  
  
  By engaging readmitted patients we have illuminated areas for future interventions, including better symptom management and self-care planning before discharge, more clarity in discharge instructions, promoting awareness of outpatient resources, and improved alignment of patient and provider attitudes about readmissions. As the United States strives to reduce readmissions, attending to the patient perspective is critical in informing appropriate avenues for quality improvement. Journal of Hospital Medicine 2016;11:407-412. © 2016 Society of Hospital Medicine.
authors.affiliation: Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Jessica
authors.initials: J
authors.lastname: Howard-Anderson
authors.affiliation: Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Ashley
authors.initials: A
authors.lastname: Busuttil
authors.affiliation: David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lonowski
authors.affiliation: Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Vangala
authors.affiliation: Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
authors.forename: Nasim
authors.initials: N
authors.lastname: Afsar-Manesh
mesh_terms: D000046:Academic Medical Centers; D005260:Female; D006761:Hospitals; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000592:standards; D014481:United States