Shoshana J Herzig1,2, Jeffrey L Schnipper3,4, Lauren Doctoroff5,3, Christopher S Kim6, Scott A Flanders6, Edmondo J Robinson7, Gregory W Ruhnke8, Larissa Thomas9,10, Sunil Kripalani11,12, Peter K Lindenauer13, Mark V Williams14, Joshua P Metlay15, Andrew D Auerbach16. 1. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA. sherzig@bidmc.harvard.edu. 2. Harvard Medical School, Boston, MA, USA. sherzig@bidmc.harvard.edu. 3. Harvard Medical School, Boston, MA, USA. 4. Hospitalist Service, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. 5. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 1309 Beacon Street, 2nd Floor, Brookline, MA, 02446, USA. 6. Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 7. Value Institute and Department of Medicine, Christiana Care Health System, Wilmington, DE, USA. 8. Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA. 9. Division of Hospital Medicine, San Francisco General Hospital, San Francisco, CA, USA. 10. University of California, San Francisco, San Francisco, CA, USA. 11. Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA. 12. Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA. 13. Center for Quality of Care Research and Department of Medicine, Baystate Medical Center, Springfield, MA, USA. 14. Center for Health Services Research, University of Kentucky, Lexington, KY, USA. 15. Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. 16. Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA.
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.
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.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Andrew D Auerbach; Mitesh S Patel; Joshua P Metlay; Jeffrey L Schnipper; Mark V Williams; Edmondo J Robinson; Sunil Kripalani; Peter K Lindenauer Journal: Acad Med Date: 2014-03 Impact factor: 6.893
Authors: Nazima Allaudeen; Jeffrey L Schnipper; E John Orav; Robert M Wachter; Arpana R Vidyarthi Journal: J Gen Intern Med Date: 2011-03-12 Impact factor: 5.128
Authors: Suzanne E Mitchell; Paula M Gardiner; Ekaterina Sadikova; Jessica M Martin; Brian W Jack; Judith H Hibbard; Michael K Paasche-Orlow Journal: J Gen Intern Med Date: 2013-10-04 Impact factor: 5.128
Authors: Stephanie Rennke; Oanh K Nguyen; Marwa H Shoeb; Yimdriuska Magan; Robert M Wachter; Sumant R Ranji Journal: Ann Intern Med Date: 2013-03-05 Impact factor: 25.391
Authors: Eduard E Vasilevskis; Joseph G Ouslander; Amanda S Mixon; Susan P Bell; J Mary Lou Jacobsen; Avantika A Saraf; Daniel Markley; Kelly C Sponsler; Jill Shutes; Emily A Long; Sunil Kripalani; Sandra F Simmons; John F Schnelle Journal: J Am Geriatr Soc Date: 2016-12-16 Impact factor: 5.562
Authors: Marina S McCreight; Heather M Gilmartin; Chelsea A Leonard; Ashlea L Mayberry; Lynette R Kelley; Brandi K Lippmann; Andrew S Coy; Tiffany A Radcliff; Murray J Côté; Robert E Burke Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Steven P Gerke; Jon D Agley; Cynthia Wilson; Ruth A Gassman; Philip Forys; David W Crabb Journal: Am J Med Qual Date: 2018-01-18 Impact factor: 1.852
Authors: Kelly L Graham; Andrew D Auerbach; Jeffrey L Schnipper; Scott A Flanders; Christopher S Kim; Edmondo J Robinson; Gregory W Ruhnke; Larissa R Thomas; Sunil Kripalani; Eduard E Vasilevskis; Grant S Fletcher; Neil J Sehgal; Peter K Lindenauer; Mark V Williams; Joshua P Metlay; Roger B Davis; Julius Yang; Edward R Marcantonio; Shoshana J Herzig Journal: Ann Intern Med Date: 2018-05-01 Impact factor: 25.391