Parent and Provider Perspectives on Pediatric Readmissions: What Can We Learn About Readiness for Discharge?

Abstract

BACKGROUND: Readmissions are an increasingly recognized quality metric that will likely affect payments to children’s hospitals. Our aim was to inform future efforts to reduce readmissions by eliciting parent and provider perceptions of pediatric readmissions. METHODS: We interviewed English- and Spanish-speaking parents and inpatient providers of children with medical diagnoses who had unplanned readmissions (≤7 days). Parents were interviewed one-on-one during the readmission. Providers were interviewed in person or by phone within 1 week of the patient’s second discharge. Interviewees were queried about their perceptions of the reason for readmission and whether the readmission was preventable. Interview transcripts were analyzed using qualitative content methods. Code categories were developed and emergent themes independently identified by 2 analysts. RESULTS: The study included 30 readmitted children (median age 17 months, 70% male, 80% White or Hispanic, and 66% publically insured). We interviewed 30 parents (23% Spanish speaking) and 27 discharging or readmitting providers. Parents and providers identified several major factors as causing readmissions, including child related (health and symptoms), parent/family related (adherence to recommended care), provider/team related (medical management), communication difficulties, home supports, and quality of discharge teaching. Parents and providers had differing interpretations of the role or magnitude of these factors. Lack of shared understanding between parents and providers emerged as a potentially important cause of readmissions. CONCLUSIONS: We identified lack of shared understanding and communication difficulties between parents and providers as potential causes of readmission. Further research is needed to determine if improvements in identifying and addressing such problems can reduce pediatric readmissions.