A recent study published in BMJ Quality & Safety found that hospital patients who reported high satisfaction with their care and good communication with their providers were also less likely to be readmitted within 30 days of discharge.

These findings suggest that engaging patients in an assessment of communication quality, unmet needs, concerns, and overall experience during their hospital stay may help identify issues that have not been captured in standard, post-discharge surveys that are conducted when an opportune time for quality improvement interventions has passed.

- Lead author, Jocelyn Carter, MD, MPH, Department of Medicine, Massachusetts General Hospital, Boston, MA

Hospital care accounts for nearly one third of US health-care expenditures, yet an estimated 15 to 20% of these costs are potentially preventable, Dr. Carter and her colleagues noted.

Studies on risk of readmission typically haven’t used patient experience data, and those that did focused on care after discharge. Until now, no studies have investigated patients’ predictions of readmission during their hospital stay.

Satisfaction and communication

For this study, researchers surveyed patients on either the day of or the day before discharge from two of Massachusetts General’s internal medicine units.

Participating patients answered questionnaires that asked about their perceptions of their physical and mental health, satisfaction with the care they received, confidence in their ability to care for themselves, understanding of their care plans, and whether they thought they might need to be readmitted within the next month.

Of the 846 patients who were surveyed, 201 had an unplanned readmission within 30 days. The most common reasons for readmission were infectious disease, respiratory illness, cardiac disease, gastrointestinal bleeding, or a psychiatric diagnosis.

It was found that patients who reported being “very satisfied” with their overall inpatient care were 39% less likely to be readmitted (after adjusting baseline differences) than patients who were not as satisfied.

Patients who indicated that their physicians “always listened to them carefully” were 32% less likely to be readmitted.

Although patients who predicted they were “very likely” to be readmitted were at an increased risk of readmission, this association was not statistically significant. Other factors associated with an increased risk of readmission—such as a limited level of education—were similar to those seen in earlier studies.

The researchers concluded that patients who reported high satisfaction and good provider communication were less likely to be readmitted.

Risks of readmission

“Surprisingly, there was no increased likelihood of readmission associated with specific levels of insurance, but that may be related to the universal health insurance coverage in Massachusetts during those years,” said Dr. Carter, who is also an instructor in medicine at Harvard Medical School.

Researchers also found that patients over the age of 45 were more likely to be readmitted than younger patients, while previous studies have found increased risk only in those over 65. The fact that our study was conducted in units caring for patients with complex health needs could affect risk across all age categories.

Further research is needed to learn how these findings can help proactively identify patients who are at increased risk of readmission.

To read more about this study, click here.

The study was supported by a Clinician Teacher Development Award from the Massachusetts General Physicians Organization.