How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

Abstract

Background A large number of articles examined the preventability rate of readmissions, but comparison and interpretability of these preventability rates is complicated due to the large heterogeneity of methods that were used. To compare (the implications of) the different methods used to assess the preventability of readmissions by means of medical record review. Methods A literature search was conducted in PUBMED and EMBASE using “readmission” and “avoidability” or “preventability” as key terms. A consensus-based narrative data synthesis was performed to compare and discuss the different methods. Results Abstracts of 2504 unique citations were screened resulting in 48 full text articles which were included in the final analysis. Synthesis led to the identification of a set of important variables on which the studies differed considerably (type of readmissions, sources of information, definition of preventability, cause classification and reviewer process). In 69% of the studies the cause classification and preventability assessment were integrated; meaning specific causes were predefined as preventable or not preventable. The reviewers were most often medical specialist (67%), and 27% of the studies added interview as a source of information. Conclusion A consensus-based standardised approach to assess preventability of readmission is warranted to reduce the unwanted bias in preventability rates. Patient-related and integrated care related factors are potentially underreported in readmission studies. Electronic supplementary material The online version of this article (10.1186/s12874-019-0766-0) contains supplementary material, which is available to authorized users.

Towards a patient journey perspective on causes of unplanned readmissions using a classification framework: results of a systematic review with narrative synthesis

“…In 2017, we conducted a systematic review on (the implications of) the different methods used to assess the preventability of unplanned readmissions by use of patient record review [10]. Previous studies demonstrated that health administrative databases often lack extensive information (e.g.…”

“…The 77 studies which were included in the previous review [10] were checked for eligibility for this review by two researchers (CB and RS) (see Additional file 2). Studies were included if they fulfilled to the following criteria: original data, primary focus on preventable readmissions, clear description of preventable readmissions and potential causes of preventable readmissions (the cause classification) (see Additional file 3).…”

“…In our previous review, we found that the definition of preventability varied widely among studies. Many studies did not provide a clear definition, but referred to a cause classification with causes that were pre-defined as preventable [10]. For instance, Williams et al defined potential areas to avoid readmissions; ‘It was noted that readmission could have been avoided if more effective action had been taken in one or more of five areas: preparation for and timing of discharge, attention to the needs of the carer, timely and adequate information to the general practitioner and subsequent action by the general practitioner, sufficient and prompt nursing and social services support, and management of medication’ [13].…”

Preventability of unplanned readmissions within 30 days of discharge. A cross-sectional, single-center study

“…Measuring preventability, however, poses some challenges since it lacks a clear definition and objective measuring tool. This causes confusion in methodology and comparability of study results, possibly explaining the wide variety in reported preventable readmissions [5][6][7][8][9][10]. In a review on hospital admissions considered avoidable, a preventability proportion between 5% and 79% was reported [7].…”

Patients’ and providers’ perspectives on medication relatedness and potential preventability of hospital readmissions within 30 days of discharge

“…This assumed that readmissions are preventable. Measuring the preventability of readmissions is a challenge, because uniform factors related to preventable readmissions and a clear definition of ‘preventability’ have not been established . Feigenbaum et al found that on average, 8.7 factors contributed to each potentially preventable readmission.…”