Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey.
The transition out of the hospital is a vulnerable time for patients, relying heavily on communication and coordination of resources across care settings. Understanding the perspectives of inpatient and outpatient physicians regarding factors contributing to readmission and potential preventive strategies is crucial in designing appropriately targeted readmission prevention efforts.



To examine and compare inpatient and outpatient physician opinions regarding reasons for readmission and interventions that might have prevented readmission.



Cross-sectional multicenter study.



We identified patients readmitted to general medicine services within 30 days of discharge at 12 US academic medical centers, and surveyed the primary care physician (PCP), discharging physician from the index admission, and admitting physician from the readmission regarding their endorsement of pre-specified factors contributing to the readmission and potential preventive strategies.



We calculated kappa statistics to gauge agreement between physician dyads (PCP-discharging physician, PCP-admitting physician, and admitting-discharging physician).



We evaluated 993 readmission events, which generated responses from 356 PCPs (36 % of readmissions), 675 discharging physicians (68 % of readmissions), and 737 admitting physicians (74 % of readmissions). The most commonly endorsed contributing factors by both PCPs and inpatient physicians related to patient understanding and ability to self-manage. The most commonly endorsed preventive strategies involved providing patients with enhanced post-discharge instructions and/or support. Although PCPs and inpatient physicians endorsed contributing factors and potential preventive strategies with similar frequencies, agreement among the three physicians on the specific factors and/or strategies that applied to individual readmission events was poor (maximum kappa 0.30).



Differing opinions among physicians on factors contributing to individual readmissions highlights the importance of communication between inpatient and outpatient providers at discharge to share their different perspectives, and suggests that multi-faceted, broadly applied interventions may be more successful than those that rely on individual providers choosing specific services based on perceived risk factors.
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA. sherzig@bidmc.harvard.edu.|Harvard Medical School, Boston, MA, USA. sherzig@bidmc.harvard.edu.
Shoshana J
SJ
Herzig
Harvard Medical School, Boston, MA, USA.|Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
Jeffrey L
JL
Schnipper
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA.|Harvard Medical School, Boston, MA, USA.
Lauren
L
Doctoroff
Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Christopher S
CS
Kim
Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Scott A
SA
Flanders
Value Institute and Department of Medicine, Christiana Care Health System, Wilmington, DE, USA.
Edmondo J
EJ
Robinson
Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Gregory W
GW
Ruhnke
Division of Hospital Medicine, San Francisco General Hospital, San Francisco, CA, USA.|University of California, San Francisco, San Francisco, CA, USA.
Larissa
L
Thomas
Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA.|Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA.
Sunil
S
Kripalani
Center for Quality of Care Research and Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
Peter K
PK
Lindenauer
Center for Health Services Research, University of Kentucky, Lexington, KY, USA.
Mark V
MV
Williams
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
Joshua P
JP
Metlay
Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
Andrew D
AD
Auerbach
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D058006:General Practice / Q000592:standards / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000592:standards* / Q000639:trends; D010820:Physicians / Q000523:psychology* / Q000592:standards* / Q000639:trends; D011795:Surveys and Questionnaires; D000069341:Transitional Care / Q000592:standards* / Q000639:trends
causes; physician opinion; prevention; readmissions; survey