Risks for unplanned hospital readmission in a teaching hospital in southern Taiwan

Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study

ACCESSIBLE SUMMARY

What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge. Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service. What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital. While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision. What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices. The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms.

INTRODUCTION

Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users.

AIM

The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital.

METHOD

This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users.

RESULTS

The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital.

IMPLICATIONS FOR PRACTICE

This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged.

Rehospitalization of older adults discharged to home hospice care

BACKGROUND

Acute hospital readmission of older adults receiving hospice care is not aligned with hospice goals.

OBJECTIVE

To identify factors associated with 30-day readmission among older adults newly discharged to hospice.

DESIGN/SUBJECTS

Medical record review of 59 patients, 19 readmitted within 30 days and 40 randomly selected controls not readmitted, from 206 patients newly discharged to home hospice care between February 1, 2005 and January 31, 2010. Measures/Analysis: Information was collected about hospital course, end-of-life planning, and posthospitalization follow-up. We calculated bivariate associations and developed a Cox Proportional Hazards model examining the relation between index admission characteristics and readmission.

RESULTS

Patients' mean age was 79.7±8.4; 74.6% were female; 52.5% were black. Among those readmitted, 25% had received a palliative care consultation, compared to 47.1% of those not readmitted (p=0.06). Patients without a participating decision-maker involved in their hospice decision had 3.5 times the risk of readmission within 30 days, compared to those with (hazard ratio [HR] 3.53, confidence interval [CI] 0.97, 12.82). Patients who had one or more telephone contacts with their primary care physician (PCP) during week 1 after discharge had 2.4 times the readmission risk within 30 days, compared to patients with no such contacts during this period (HR 2.35, CI 0.9, 6.1).

CONCLUSIONS

Readmission within 30 days of initial discharge to hospice is associated with several measures of care and care planning. Further study of these measures may identify opportunities for interventions to improve the hospital-to-hospice transition and to decrease hospital readmissions.

A study on investigating unplanned readmission patterns

AIM

To explain frequent hospital readmissions, this study aimed to determine whether definable subtypes exist within a cohort of subjects with chronic illness with regard to factors associated with a patient's readmission patterns and to compare whether these factors vary between subjects in groups with different profiles.

RESEARCH METHOD

A descriptive correlational survey was conducted and data were collected by using a structured questionnaire. Seventy-four readmitted subjects were recruited in three general hospitals in Hong Kong.

OUTCOME MEASURES

Five outcome variables were employed in the study: predisposing characteristic, need factors, health behaviour, health status or outcomes and enabling resources.

RESULTS

A cluster analysis yielded two clusters. Each cluster represented a different profile of the sample on patient use of healthcare services. Cluster A consisted of 41.9% (n = 31) and Cluster B consisted of 58.1% (n = 43) of the patients. Cluster A patients, more of whom were male, were younger, more educated, had higher activities of daily living scores and fewer of them had received community nurse services than patients of Cluster B. Cluster A patients (32.3%) had more than one readmission record within 28 days than Cluster B patients (9.3%, p = 0.017).

CONCLUSION

Our study shows that community nurse services can reduce the rate at which they are readmitted a second time. However, such services may have a positive effect only on a group of patients whose profile is similar to the patients in Cluster B and not for patients such as those in Cluster A. A clear profile may help healthcare policy makers make appropriate strategies to target a specific group of patients to reduce their readmission rates.

RELEVANCE TO CLINICAL PRACTICE

The identification of risk for future healthcare use could enable better targeting of interventional strategies within these groups. The results of this study might provide hospital managers with a model to design specified interventions to reduce unplanned hospital readmissions for each profile group.

Home-care clients' need for help, and use and costs of services

The aims of the study were to describe (1) the need for help as well as the use and costs of services of home help and/or home nursing (home care) and (2) to identify the variables associated with the use and costs of health and social care services. A total of 721 Finnish home-care clients were interviewed in 2001. The need for help was assessed by basic and instrumental activities of daily Living (ADL) and in terms of pain and illness, rest and sleep, psychosocial well-being and social and environment variables. The Anderson-Newman model was used to study predictors of use of services, including visits of home-care personnel and visits to the doctor, nurse, physiotherapist, laboratory and hospital. Weekly costs of services were calculated. Data were analyzed using multivariate analyses. The clients had poor functional ability and they needed help at least once a week with, on average, 6 out of 15 ADL functions, and 5 out of 13 items relating to pain and illnesses, rest and sleep, psychosocial well-being and social and environment items. The enabling and need variables, particularly the variables "living alone" and "perceived need for help", were important predictors for the use of services. Social care constituted more than half of the average weekly costs of municipalities. The perceived need for help with basic ADL was associated with higher costs. To ensure the quality of life among home-care clients while keeping costs reasonable is a challenge for municipalities.