Older people’s experiences and factors associated with hospital readmission: a mixed methods study

Abstract

Hospital readmission is a multifactorial issue that negatively impacts older people’s lives and the healthcare system. Current literature pertaining to hospital readmission focuses on clinical outcomes based on cross-sectional data whilst research exploring patients’ experiences and priorities is limited. The present mixed methods study explored the factors that matter most to older people who may have had an experience of readmission and examined whether these factors were integrated into routinely collected hospital data.

This study was conducted with three interconnected Phases. Phase 1 adopted a qualitative approach with the involvement of individuals from a Patient Public Involvement group in order to review and finalise the interview schedule that was used in Phase 2. Semi-structured qualitative interviews were conducted in Phase 2, to identify factors linked to hospital readmission that were analysed using principles of interpretative phenomenological analysis and informed the subsequent Phase. Phase 3 included a cross-sectional retrospective analysis of primary routinely collected clinical data to examine if the main factors identified in Phase 2 were reflected in the UHS database and if so, identify their relationship with hospital readmission.

Phase 1 - 10 people aged 65 years and over were recruited. Phase 2 - 10 people aged 65 years and over, who have had an experience of hospital readmission within a period of 30 days were recruited from a large single tertiary referral centre. Phase 3 used a dataset of 2708 patients, of which 159 had been readmitted.

The qualitative interview schedule was developed and finalised with input from the PPI group in Phase 1. Four superordinate themes were identified in phase 2: ‘All about me without me’, ‘Fragmented and ad hoc post-discharge support’, ‘My readmission experience and what led me back’ and ‘Segregated health and social services that are detached from people’s needs’. The factors that mattered the most to participants in Phase 2 were mainly concerned with discharge planning and patient understanding, engagement with, and access to post-discharge resources, and formal and informal support. In phase 3, emergency admission, shorter length of stay, number of comorbidities and medication, postcode prefix, having a planned follow up, and living alone were identified as factors that increased the likelihood of hospital readmission.

This study adds important findings on how discharge planning improves when readmitted and patients highlighted clinical and non-clinical factors such as Shared Decision Making, Activities of Daily Living, lack of physiotherapy as important to them and identified these as some of the reasons for their readmission. Non-clinical factors related to patients' everyday contexts are likely to be at least as important as clinical indicators for readmission, however, such data is not routinely collected.

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Identifiers

ORCID for Fanis Stavrou: orcid.org/0000-0002-9241-8839

ORCID for Dinesh Samuel: orcid.org/0000-0003-3610-8032

ORCID for Ivaylo Vassilev: orcid.org/0000-0002-2206-8247

ORCID for Jo Adams: orcid.org/0000-0003-1765-7060

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