title: Preventability of Hospital Readmissions From Skilled Nursing Facilities: A Consumer Perspective.
abstract: A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission.
  
  
  
  Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge. Mixed analytical methods were applied, including a content analysis that evaluated factors contributing to hospital readmission as perceived by consumers.
  
  
  
  Among 208 attempted interviews, 156 were completed, of which 53 (34%) respondents rated their readmission as preventable. 28.3% of the 53 consumers attributed the readmission to hospital factors, 52.8% attributed it to the SNF, and 18.9% believed both sites could have prevented the readmission. The primary driver of the readmission was a family member/caregiver in 31 cases and the patient in 24 of the 156 cases, amounting to 55 (35.3%) consumer-driven readmissions. Contributing factors included: premature hospital discharge (16.3%); poor discharge planning (16.3%); a clinical issue not resolved in the hospital (14.3%); inadequate treatment at the SNF (69.4%); improper medication management at the SNF (20.4%); and poor decision-making regarding the transfer (14.3%).
  
  
  
  Interviewing readmitted patients provides information relevant to reducing readmissions that may otherwise be omitted from hospital and SNF records. Consumers identified quality issues at both the hospital and SNF and perceived themselves as initiating a significant number of readmissions.
authors.affiliation: Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.
authors.forename: J Mary Lou
authors.initials: JML
authors.lastname: Jacobsen
authors.affiliation: Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.|Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Avantika A
authors.initials: AA
authors.lastname: Saraf
authors.affiliation: Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Long
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D000359:Aftercare / Q000379:methods / Q000523:psychology; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000379:methods; D058996:Quality Improvement / Q000458:organization & administration*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States
keywords: Care transition; Continuum of care; Medicare; Mixed-methods; Person-centered care; Post-acute care; Quality of care; Rehospitalization