Objective: To understand factors leading to all-cause 30-day readmissions in a community hospital population.
Research Design: Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team.
Setting: Eighteen Kaiser Permanente Northern California hospitals.
Results: Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management.
Conclusions: Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified.
*The Permanente Medical Group
†Kaiser Permanente Care Management Institute
‡Kaiser Foundation Health Plan, Northern California Region, Oakland, CA
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The authors declare no conflict of interest.
Reprints: Estee Neuwirth, PhD, Care Management Institute, One Kaiser Plaza, 16th Floor, Oakland, CA 94612. E-mail: Estee.Neuwirth@kp.org.