Patient-reported oncology readmission factors.

Abstract

48 Background: Reducing the risk of readmissions is an important quality goal for hospitals. Little is known of the perspectives of patients on underlying challenges that may lead to readmission. The objective of this study was to elicit perspectives of readmitted oncology patients on barriers to a successful transition from hospital to home. Methods: As part of a larger survey of readmitted inpatients, a 36-item survey was administered to 197 oncology patients readmitted to the hospital within 30 days of discharge to home. Surveys were administered at The Hospital of the University of Pennsylvania (an urban tertiary care academic medical center) and Penn Presbyterian Medical Center (an affiliated urban community hospital), both located in Philadelphia. Responses were entered in real-time into the electronic medical record (EMR) and used by the care team to address patient concerns and improve quality. Results: 45.2% of readmitted oncology patients reported challenges during the transition from hospital to home which they perceived as contributing to readmission. The most commonly reported transition challenges within the oncology population included difficulty with activities of daily living (ADLs) (17.8%), feeling unprepared for discharge (14.2%) and difficulty adhering to medications (7.1%). 15.2% of patients could not identify any modifiable factor contributing to readmission and reported returning simply because of symptoms from progressive illness. After adjusting for potential confounders (age, gender and severity of illness) using multivariable logistic regression models, uninsured and Medicaid patients were more likely than other patients to attribute readmission to difficulty accessing medications (OR 4.5, 95%CI 1.0, 19.9) and performing ADLs (OR 2.7, 95%CI 1.18, 6.1). Conclusions: Understanding challenges reported by readmitted oncology patients may enable inpatient oncologists to tailor transitions interventions to patient needs. Specifically, ensuring patients are able to perform necessary ADLs, are prepared for discharge and have assistance with medication adherence may help prevent unplanned readmissions. Uninsured and Medicaid patients may require additional assistance with accessing medications and ADLs.