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Title: Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study.
Authors: Mukhopadhyay, Amartya 
Mohankumar, Bhuvaneshwari
Chong, Lin Siew 
Hildon, Zoe JL 
Tai, Bee Choo 
Quek, Swee Chye 
Keywords: Hospitals
Length of Stay
Patient Readmission
Retrospective Studies
Risk Factors
Issue Date: Oct-2021
Publisher: Academy of Medicine, Singapore
Citation: Mukhopadhyay, Amartya, Mohankumar, Bhuvaneshwari, Chong, Lin Siew, Hildon, Zoe JL, Tai, Bee Choo, Quek, Swee Chye (2021-10). Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study.. Annals Academy of Medicine Singapore 50 (10) : 751-764. ScholarBank@NUS Repository.
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.
Source Title: Annals Academy of Medicine Singapore
ISSN: 03044602
DOI: 10.47102/annals-acadmedsg.2020522
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