Physician Perspectives on Factors Contributing to Readmissions and Potential Prevention Strategies: A Multicenter Survey

Shoshana J. Herzig, Jeffrey L. Schnipper, Lauren Doctoroff, Christopher S. Kim, Scott A. Flanders, Edmondo J. Robinson, Gregory W. Ruhnke, Larissa Thomas, Sunil Kripalani, Peter K. Lindenauer, Mark V. Williams, Joshua P. Metlay, Andrew D. Auerbach

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Background: 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. Objective: To examine and compare inpatient and outpatient physician opinions regarding reasons for readmission and interventions that might have prevented readmission. Design: Cross-sectional multicenter study. Participants: 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. Main Measures: We calculated kappa statistics to gauge agreement between physician dyads (PCP-discharging physician, PCP-admitting physician, and admitting-discharging physician). Key Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)1287-1293
Number of pages7
JournalJournal of General Internal Medicine
Volume31
Issue number11
DOIs
StatePublished - Nov 1 2016

Bibliographical note

Funding Information:
The study was funded through an unrestricted research grant from the American Association of Medical Colleges, and in part by 2 UL1 TR000445-06 from the National Center for Advancing Translational Sciences. Dr. Auerbach was supported by NHLBI K24HL098372, and Dr. Herzig was supported by NIA K23AG042459. The funding organizations had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
© 2016, Society of General Internal Medicine.

Keywords

  • causes
  • physician opinion
  • prevention
  • readmissions
  • survey

ASJC Scopus subject areas

  • Internal Medicine

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