Factors Contributing to All-cause 30-day Readmissions A Structured Case Series Across 18 Hospitals
Factors Contributing to All-cause 30-day Readmissions A Structured Case Series Across 18 Hospitals
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DOI：
10.1097/mlr.0b013e318249ce72
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发表时间：
2012-07-01
期刊：
影响因子：
3
通讯作者：
Bellows, Jim
中科院分区：
文献类型：
--
作者：
Feigenbaum, Paul;Neuwirth, Estee;Bellows, Jim
目的：了解导致社区医院人群 30 天全因再入院的因素。研究设计：使用图表审查、对治疗医生、患者和家庭护理人员的访谈以及护士-医生团队的整体病例评估，对 537 例再入院进行结构化病例系列。地点：北加州 18 家 Kaiser Permanente 医院。结果：对 47% (250) 的再入院进行了评估 可能是可以预防的； 11% (55) 被评估为非常或完全可以预防； 36% (195) 认为可以轻度或中度预防。平均而言，每次可预防的再入院有 8.7 个因素造成。因素与指数住院期间的护理（143 例，占可能可预防的再入院的 57%）、出院过程（168 例，67%）和后续护理（197 例，79%）有关。错失防止再入院的机会也与质量改进重点领域有关：过渡护理计划和护理协调、临床护理、后续护理后勤、预先护理计划和临终关怀以及药物管理。结论：在基线再入院率较低的综合医疗保健系统中，多种因素导致了潜在可预防的再入院。减少全因 30 天再入院可能需要采取综合方法来解决这些领域的问题。未来的质量改进工作和研究应该确定现有的和新的策略，通过解决我们发现的错失的机会，可以最好地防止再入院。
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.