Physician Perspectives on Readmissions

Journal of General Internal Medicine, May 2017

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Physician Perspectives on Readmissions

Physician Perspectives on Readmissions Ami Schattner ) 0 1 0 1. Herzig SJ, Schnipper JL, Doctoroff L, et al. Physician perspectives on factors contributing to readmissions and potential prevention strategies: a multicenter survey. J Gen Intern Med. 2016;31:1287-1293. 2. Feigenbaum P , Neuwirth E, Trowbridge L, et al. Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals. Med Care. 2012;50:599-605. 3. Balla U, Malnick S , Schattner A. Early readmissions to the department of medicine as a screening tool for monitoring quality of care problems. Medicine (Baltimore). 2008;87:294-300. 4. Ashton CM, Kuykendall DH , Johnson ML, et al. The association between the quality of inpatient care and early readmission. Ann Intern Med. 1995;122:415-421. 5. van Walraven C, Bennett C , Jennings A, et al. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011;183:E391-E402. 6. Horwitz LI, Wang Y, Desai MM, et al. Correlations among risk- standardized mortality rates and among risk-standardized readmission rates within hospitals. J Hosp Med. 2012;7:690-696. 7. Nijhawan AE , Kitchell E, Etherton SS, et al. Half of 30-day hospital readmissions among HIV-infected patients are potentially preventable. AIDS Patient Care STDs. 2015;29:465-473 1 The Faculty of Medicine, Hebrew University and Hadassah Medical School , Jerusalem , Israel Looking at “Problems with the index admission” plus inadequate Compliance with Ethical Standards: Funding: None. - T o the Editor: Herzig et al. are to be commended on their large prospective multicenter study of readmissions1—a problem which is common, costly, complex (multifactorial), and often preventable.2 However, one of their main findings, that patient factors have the major role in readmissions as judged by physicians’ perceptions, may not be as sound as it seems. The all too human tendency to assign flaws to others while having an exaggerated self-opinion and failing to acknowledge weaknesses in their own field may have skewed the results, with significant implications. This is strongly supported when noting that primary physicians perceived “problems with the index admission” (i.e. hospital-associated quality of care [QOC] issues) in over a third of the patients, much more frequently than the discharging physicians were critical of their own performance regarding the 993 readmitted patients evaluated (36.5 vs. 14%, χ2 = 67.68, P < 0.01)1 Indeed, when a mix of 271 consecutive unplanned readmissions to a general medical service and matched controls who were not readmitted was blindly evaluated in our prospective study, 90 readmitted patients (33%) had quality of care problems vs. 6% among controls (P < 0.001).3 All these readmissions were deemed preventable. Other investigators have also identified a significantly increased quota of preventable readmissions associated with well-defined QOC deficiencies.4–7 As a result, readmission to the hospital shortly after discharge is increasingly recognized as a marker of inpatient This important aspect is underplayed in the current study. Efforts to reduce readmissions should focus not only on patient-related factors, but on identifying and correcting essential care and communication issues (including contextual problems) in the realm of the hospital providers. These can be identified only through a largesample peer review process based on expert opinion.

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Physician Perspectives on Readmissions, Journal of General Internal Medicine, 2017, DOI: 10.1007/s11606-017-4024-z