Acute Care/Hospitalization

Life challenges, not discharge problems, cause repeat hospitalizations

Patients who end up back in the hospital with the same condition that put them there just months earlier may need more than medical advice when they're discharged, a new study finds. Researchers interviewed 21 "rehospitalized" patients at Boston Medical Center over a 4-month period. A rehospitalized patient was one who had been previously admitted within 6 months for the same condition. >Study participants were mostly low-income minorities who lived in the inner city of Boston.

Previous studies claim that poorly executed discharges are the reason one in four patients end up back in the hospital within 90 days of discharge. Examples of discharge problems include patients' lack of health literacy, poor coordination between the hospital and the patients' regular care providers, and inadequate followup after discharge. However, this study found that patients' life circumstances caused readmission more often than these discharge problems.

Patients could readily explain their conditions, list their medications, and repeat the medical instructions they received. Because of their home lives, however, the behavioral changes they were instructed to make were not simple tasks. For example, single mothers who were told to rest after their discharge often found they could not locate stand-in caregivers for their children. Alcoholic and diabetic patients found changing their drinking and eating habits difficult, because stressful living situations left them depressed.

The discharge process should include assessing what social support a patient needs to be successful after a hospitalization, the authors suggest. Providing information on nonprofit organizations that provide counseling, meals, child care, or housekeeping services could also reduce rehospitalization rates.

This study was funded by the Agency for Healthcare Research and Quality (HS14289 and HS15905).

See "Understanding rehospitalization: Can hospital discharge be modified to reduce recurrent hospitalization?" by Lee Strunin, Ph.D., Meg Stone, M.P.H., and Brian Jack, M.D., in the September/October 2007 Journal of Hospital Medicine 2(5), pp. 297-304.

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