Pathways to potentially preventable hospitalizations for diabetes and heart failure: a qualitative analysis of patient perspectives.

Tetine L Sentell,Michelle L Quensell,May Vawer,Todd B Seto,Kathryn L Braun,Malia M Young,Deborah A Taira

doi:10.1186/s12913-016-1511-6

Abstract

BackgroundPotentially preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually. Studies about PPH typically lack patient perspectives, especially across diverse racial/ethnic groups with known PPH health disparities.MethodsEnglish-speaking individuals with a HF or DM-related PPH (n = 90) at the largest hospital in Hawai‘i completed an in-person interview, including open-ended questions on precipitating factors to their PPH. Using the framework approach, two independent coders identified patient-reported factors and pathways to their PPH.ResultsSeventy-two percent of respondents were under 65 years, 30 % were female, 90 % had health insurance, and 66 % had previously been hospitalized for the same problem. Patients’ stories identified immediate, precipitating, and underlying reasons for the admission. Underlying background factors were critical to understanding why patients had the acute problems necessitating their hospitalizations. Six, non-exclusive, underlying factors included: extreme social vulnerability (e.g., homeless, poverty, no social support, reported by 54 % of respondents); health system interaction issues (e.g., poor communication with providers, 44 %); limited health-related knowledge (42 %); behavioral health issues (e.g., substance abuse, mental illness, 36 %); denial of illness (27 %); and practical problems (e.g., too busy, 6 %). From these findings, we developed a model to understand an individual’s pathways to a PPH through immediate, precipitating, and underlying factors, which could help identify potential intervention foci. We demonstrate the model’s utility using five examples.ConclusionsIn a young, predominately insured population, factors well outside the traditional purview of the hospital, or even clinical medicine, critically influenced many PPH. Patient perspectives were vital to understanding this issue. Innovative partnerships and policies should address these issues, including linkages to social services and behavioral health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1511-6) contains supplementary material, which is available to authorized users.

Highlights

Preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually
The study goal was to understand patient perspectives of factors that led to a Potentially preventable hospitalizations (PPH) for heart failure and diabetes so that these insights could be considered in research, clinical practice, and policy. We focused on these two conditions because they include the most common preventable hospitalizations, responsible for 39 % of all PPH [1]
This study presents the in-depth qualitative results from a larger mixed-methods study focusing on identifying and understanding disparities in PPH for heart failure and diabetes across diverse racial/ethnic groups, Asian American and Pacific Islander populations

Summary

Introduction

Preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually. Studies about PPH typically lack patient perspectives, especially across diverse racial/ethnic groups with known PPH health disparities. Hospitalizations for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually [1], yet many of these hospitalizations are considered “potentially preventable hospitalizations” (PPH). Gaining insight into sociodemographic factors is important, as a handful of previous studies have found that social factors impact the risk of hospital readmission, though research on this topic is still limited [6,7,8,9,10,11]. The vast majority of studies about these topics utilize administrative data, which typically lack key socio-demographic variables as well as patient perspectives about their PPH [6]

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Discussion

Conclusion