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Hospital Readmission From the Perspective of Medicaid and Uninsured Patients

Misky, Gregory, J.; Burke, Robert, E.; Johnson, Teresa; del Pino Jones, Amira; Hanson, Janice, L.; Reid, Mark, B.

The Journal for Healthcare Quality (JHQ): January/February 2018 - Volume 40 - Issue 1 - p 44–50
doi: 10.1097/JHQ.0000000000000083
Original Article

Background: Patients with little or no health insurance are frequently readmitted to the hospital, yet few previous studies have listened to patients' explanations of why they returned to the hospital after discharge. Enhanced understanding of patient perspectives may facilitate targeted services and improve care.

Methods: We enrolled 18 patients with Medicaid or no insurance during a hospital readmission within 30 days in a major metropolitan area, and conducted semi-structured qualitative interviews to explore the impact of patients' experiences around readmission using a grounded theory approach.

Results: We identified five themes contributing to readmission: (1) therapeutic misalignment; (2) accountability; (3) social fragility; (4) access failures; and (5) disease behavior. Medical conditions were complicated by social influences and insufficiently addressed by our health system. Patients understood the need to manage their own health but were unable to effectively execute care plans because of competing life demands and compromised relationships with health providers.

Conclusions: Our study using interviews of readmitted Medicaid and uninsured patients revealed complex illnesses complicated by social instability and health system failures. Improved patient-provider trust and shared decision-making, while addressing social determinants and expanding care coordination with community partners, provide opportunity to better meet patients' needs and decrease hospital readmission in high-risk patients.

For more information on this article, contact Gregory J. Misky at

R. E. Burke is funded by a VA HSR&D Career Development Award.

Author contributions: study concept and design: G. J. Misky, M. Reid, R. E. Burke, J. L. Hanson, A. del Pino Jones, T. Johnson. Acquisition, analysis and interpretation of the data: G. J. Misky, M. Reid, R. E. Burke, J. L. Hanson, A. del Pino Jones, T. Johnson. Drafting of the manuscript: G. J. Misky, M. Reid, R. E. Burke, J. L. Hanson, A. del Pino Jones, T. Johnson.

The authors declare no conflicts of interest.

G. J. Misky had full access to all data in the study and takes full responsibility for the accuracy and integrity of all contents in the manuscript.

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© 2018 National Association for Healthcare Quality
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