title: Was This Readmission Preventable? Qualitative Study of Patient and Provider Perceptions of Readmissions.
abstract: Readmissions are a costly, burdensome, and potentially preventable occurrence in the healthcare system. With the renewed national focus on the cost and quality of health care, readmissions have become a major target for improvement; however, in general, the viewpoints of patients and healthcare providers have not been considered in these discussions. We aimed to compare provider and patient perspectives on the preventability of hospital readmissions. We also aimed to compare the factors that patients and providers perceive as contributing to readmissions.
  
  
  
  We conducted descriptive statistics of readmissions using provider chart reviews (N = 213) on all readmissions to the University of North Carolina hospitalist service during a 6-month span. We also performed a qualitative analysis of those provider chart reviews, in addition to interviews with those readmitted patients (n = 23). We compared the percentage of providers versus patients who believed the readmission was preventable, and we explored the factors to which each group attributed the readmission.
  
  
  
  Providers stated that 30% of the readmissions were preventable, compared with only 13% of patients. Key contributing factors differed between providers and patients. Providers cited medical problems in 45% of readmissions, pain (24%), follow-up problems (22%), substance abuse (20%), and nonadherence (17%). Patients believed nothing could have been done to prevent them in 35% of readmissions, but they also cited medical problems (35%), incomplete diagnosis or treatment (22%), medication issues (17%), and system concerns (13%) as contributing to readmissions.
  
  
  
  These data suggest that patients and providers view the issue of readmissions differently and highlight potential areas for improvement.
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Jacob
authors.initials: J
authors.lastname: Stein
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Paul
authors.initials: P
authors.lastname: Ossman
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Anthony
authors.initials: A
authors.lastname: Viera
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Carlton
authors.initials: C
authors.lastname: Moore
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Brubaker
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: John
authors.initials: J
authors.lastname: French
authors.affiliation: From the Division of General Internal Medicine and Clinical Epidemiology, the School of Medicine and the School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Edmund Allen
authors.initials: EA
authors.lastname: Liles
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010359:Patient Readmission; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D036301:Qualitative Research; D011787:Quality of Health Care