Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study

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.