Factors Contributing to All-cause 30-day Readmissions: A Structured Case Series Across 18 Hospitals

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 percent (55) were assessed as very or completely preventable; and 36 percent (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 percent of potentially preventable readmissions), the discharge process (168, 67 percent), and follow-up care (197, 79 percent). 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.

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