Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

ABSTRACTIntroduction: Analysis of risk factors can pave the way for reducing unscheduled hospital readmissionsand improve resource utilisation.Methods: This was a concurrent nested, mixed method study. Factors associated with patients readmittedwithin 30 days between 2011 and 2015 at the National University Hospital, Singapore (N=104,496)were examined. Fifty patients were sampled in 2016 to inform an embedded qualitative study. Narrativeinterviews explored the periods of readmissions and related experiences, contrasted against those ofnon-readmitted patients.Results: Neoplastic disease (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.70–2.15), number ofdischarged medications (5 to 10 medications OR 1.21, 95% CI 1.14–1.29; ≥11 medications OR 1.80, 95%CI 1.66–1.95) and length of stay >7 days (OR 1.46, 95% CI 1.36–1.58) were most significantly associatedwith readmissions. Other factors including number of surgical operations, subvention class, number ofemergency department visits in the previous year, hospital bill size, gender, age, Charlson comorbidityindex and ethnicity were also independently associated with hospital readmissions. Although readmittedand non-readmitted patients shared some common experiences, they reported different psychologicalreactions to their illnesses and viewed hospital care differently. Negative emotions, feeling of being leftout by the healthcare team and perception of ineffective or inappropriate treatment were expressed byreadmitted patients.Conclusion: Patient, hospital and system-related factors were associated with readmissions, which mayallow early identification of at-risk patients. Qualitative analysis suggested several areas of improvementin care including greater empowerment and involvement of patients in care and decision making.Keywords: Comorbidity, diagnosis, hospital readmission, qualitative evaluation, socioeconomic factors