Authors:

Abstract

Introduction: Twenty percent of all medical patients of 65 years or above are readmitted within 30 days after discharge. Risk factors and predictors for readmissions have previous been examined. Despite this knowledge and countless efforts to prevent readmissions, the risk rates are still high. Therefore, we need to examine other aspects to prevent readmissions. Thus, the aim of this study is to identify multilevel factors that contribute to readmissions.

Method: Design: Cross-sectional survey study

Inclusion criteria:

•Patients aged ≥ 65 years

•Discharged from a medical ward at Horsens Regional Hospital (HRH) and readmitted to the same medical ward within 30 days after discharge

•Living in one of four surrounding municipalities to HRH.

Data collection: Data from questionnaires: Respondents were divided in five groups: readmitted patients and their relative, community-based nurses, general practitioners (GP) and hospital-based doctors.

Questionnaires were systematically developed using a qualitative method and an extensive literature search. The qualitative component involved patients and other public groups and consisted of semi-structured interviews with representatives from all response groups. The generated qualitative results were merged with known risk factors and predictors into questionnaire items. The questionnaires were pilot tested twice to minimize the risk of bias and it examines multilevel factors that contribute to readmissions. Questionnaire items were grouped into eight themes: 1) disease, 2) diagnostics, treatment and care, 3) social network, 4) organisation, 5) communication, 6) competences and knowledge, 7) resources and 8) practical aspects. The response categories consist of Likert scales, yes/no/don’t know, multiple choice and open-ended options. Readmitted patients were included between September 2020 and June 2021.

Data from registers: Data will be retrieved from Cross-Tracks. These data cover: home health care services, pre-hospital services, prescriptions, hospital services, laboratory, socioeconomics, The National Health Insurance Service Register, The Civil Registration System, and The National Patient Register. These data will be used to make a detailed descriptive analysis of the cohort of readmitted patients.

Analysis:

Data from questionnaires

Quantitative analysis:

•Descriptive analysis of factors contributing to readmissions and the level of agreement between responses

•within each patient string (a patient and his/hers relative, community-based nurse, GP and receiving hospital-based doctor)

•between the five response groups

Qualitative analysis:

•Qualitative content analysis will be used as method to analyse open-ended questions. NVivo will be used when coding the content.

Cross-Tracks data is merged with data collected from questionnaires to conduct sub-analysis.

Results: 165 readmitted patients were included in the study with a total of 132 unique patients. Of those included in the study the questionnaire response rates were on patients: 80%, relatives: 88%, GP’s: 68%, community-based nurses: 97% and hospital-based doctors: 90%.

The remaining analysis are pending.

Perspectives:

•Targeted initiatives take group specific perspectives into account when aiming to prevent readmissions

•Knowledge on the quality of health care services, the delivery hereof and the absence of services within and between sectors may indicate where and how a reorganization is needed