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Factors Contributing to All-cause 30-day Readmissions

A Structured Case Series Across 18 Hospitals

Feigenbaum, Paul, MD*; Neuwirth, Estee, PhD; Trowbridge, Linda, MBA; Teplitsky, Serge, RN; Barnes, Carol Ann, MS; Fireman, Emily, BA; Dorman, Jann, MBA; Bellows, Jim, PhD

doi: 10.1097/MLR.0b013e318249ce72
Original Articles

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:

© 2012 Lippincott Williams & Wilkins, Inc.