Affiliation:
1. National University Hospital, Singapore
2. National University of Singapore, Singapore
Abstract
ABSTRACT
Introduction: Analysis of risk factors can pave the way for reducing unscheduled hospital readmissions
and improve resource utilisation.
Methods: This was a concurrent nested, mixed method study. Factors associated with patients readmitted
within 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. Narrative
interviews explored the periods of readmissions and related experiences, contrasted against those of
non-readmitted patients.
Results: Neoplastic disease (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.70–2.15), number of
discharged 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 associated
with readmissions. Other factors including number of surgical operations, subvention class, number of
emergency department visits in the previous year, hospital bill size, gender, age, Charlson comorbidity
index and ethnicity were also independently associated with hospital readmissions. Although readmitted
and non-readmitted patients shared some common experiences, they reported different psychological
reactions to their illnesses and viewed hospital care differently. Negative emotions, feeling of being left
out by the healthcare team and perception of ineffective or inappropriate treatment were expressed by
readmitted patients.
Conclusion: Patient, hospital and system-related factors were associated with readmissions, which may
allow early identification of at-risk patients. Qualitative analysis suggested several areas of improvement
in care including greater empowerment and involvement of patients in care and decision making.
Keywords: Comorbidity, diagnosis, hospital readmission, qualitative evaluation, socioeconomic factors
Publisher
Academy of Medicine, Singapore
Cited by
3 articles.
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