Discharge Communication and Patient Involvement are Associated with Unplanned Hospital Readmissions: Results from a Validated Hospital Experience Survey
Bibliographic record
Abstract
ABSTRACTObjectivesUnplanned hospital readmissions are an indicator of quality of care, and are associated with significant costs to healthcare systems. Previous research has shown that poor communication and discharge experiences are associated with higher readmission rates. This, however, has only been examined in the short-term, and in many instances, at the hospital-level. The purpose of the study was to examine the relationship between aspects of inpatient communication and discharge instructions and unplanned readmissions at the individual-level up to one-year post-discharge. ApproachThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey was completed by patients within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records using personal health number, discharge date, and facility codes. Unplanned readmissions (yes vs. no; all causes) from 43 to 365 days post-hospital discharge comprised the outcome variable. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in their care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. Multivariate logistic regression was used to examine each question in the presence of the other predictors. Odds ratios and 95% confidence intervals were calculated. ResultsFrom April 2011 to March 2014, 24,868 patients completed a survey which was successfully linked to the corresponding inpatient record. The cohort had a mean age of 52.8±19.8 years of age (range=18-100), and was predominantly female (65.4%). 18.6% of patients (n=4,620) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. Patients who felt that they were not involved in their care decisions were more likely to be readmitted (OR=1.79; 95%CI: 1.59-2.01), as were patients who did not receive written information at discharge (OR=1.96; 95%CI: 1.83-2.11). Odds of unplanned readmissions did not differ according to understanding of medications (OR=1.08; 95%CI: 0.90-1.30), understanding responsibility for one’s health (OR=1.02; 95%CI: 0.86-1.20), or discussion of help needed when returning home (OR=1.03; 95%CI: 0.93-1.14). ConclusionOur results demonstrate that a lack of patient involvement in their care and not receiving written information at discharge is associated with increased unplanned readmission rate up to one-year post-discharge. This present study provides an example of how patient-reported measures may be linked to individual-level administrative data to drive healthcare improvements. Future research examining patient-reported hospital experience and other health system measures is warranted.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.005 | 0.000 |
| Scholarly communication | 0.000 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".