A survey of patients admitted to Massachusetts General Hospital (MGH) has found that patients reporting greater levels of satisfaction with their care and good communication with their health care providers were significantly less like to readmitted to the hospital in the 30 days after discharge. The study, the first to focus on patients’ perceptions on future readmission during their initial hospitalization, has been published in BMJ Quality & Safety.
“These findings suggest that engaging patients in an assessment of communication quality, unmet needs, concerns and overall experience during their hospital stay may help identify issues that have not been captured in standard, post-discharge surveys that are conducted when an opportune time for quality improvement interventions has passed,” says lead author Jocelyn Carter, MD, of the MGH Department of Medicine.
Hospital readmissions have been identified as a major contributor to health care costs, accounting in one survey for almost one-third of total U.S. health care expenditures. While some readmissions may be planned or unavoidable, it has been estimated that more than $8.25 billion is spent each year on potentially preventable readmissions. Previous studies have associated factors such as patients’ age, overall health and specific disease conditions with the risk for readmission; and patients’ socioeconomic conditions, level of education and racial/ethnic disparities have also been cited as contributing to risk.
Only a few studies of readmission risk factors have included information provided by patients, and those that did focused on aspects of care delivered after discharge from the hospital. To get a sense of how inpatient care might affect readmission risk, members of the MGH team interviewed patients discharged from two of the hospital’s internal medicine units from 2012 through 2015. On either the day of or the day before discharge, participating patients were administered questionnaires covering their own perceptions of their physical and mental health, their satisfaction with the care they received, confidence in their ability to care for themselves, understanding of their care plans and whether they thought they might need to be readmitted within the next month.
Of the 846 patients who were interviewed, 201 had an unplanned readmission during the following 30 days. The most common reasons for readmission were infectious disease, respiratory illness, cardiac disease, gastrointestinal bleeding or a psychiatric diagnosis. After adjustments for demographic factors associated with readmission risk, patients who reported being very satisfied with their overall inpatient care were 39 percent less likely to be readmitted than were patients who were not as satisfied, and those indicating that their doctors always listened to them carefully were 32 percent less likely to be readmitted.
While patients who reported that their caregivers talked with them about whether they would have help after their hospital stay were somewhat more likely to be rehospitalized, the researchers note that the questioning may reflect efforts to improve care for patients with clear needs for increased support. Patients who predicted they were “very likely” to be readmitted were at increased risk of readmission, but that finding was also not statistically significant. The impact of factors previously associated with an increased readmission risk – such as a limited level of education – was similar to what was seen in earlier studies.
Carter notes, “Surprisingly, there was no increased likelihood of readmission associated with specific levels of insurance, but that may be related to the universal health insurance coverage in Massachusetts during those years. We also found that patients over the age of 45 were more likely to be readmitted than younger patients, while previous studies have found increased risk only in those over 65. The fact that our study was conducted in units caring for patients with complex health needs could affect risk across all age categories. Now additional research is needed to examine how these data can help prospectively identify those at increased risk for readmission.”
Carter is an instructor in Medicine at Harvard Medical. Karen Donelan, ScD, EdM, of the MGH Department of Medicine and the Mongan Institute Health Policy Center is senior author of the BMJ Quality & Safety report. Additional co-authors are Charlotte Ward, MPH, Northwestern University Center for Healthcare Statistics, and Deborah Wexler, MD, MGH Diabetes Center. The study was supported by a Clinician Teacher Development Award from the Massachusetts General Physicians Organization.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."
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