Since the study has dealt with the combination of exploratory and descriptive designs for employing a mixed-methods approach to data collection, the results of different statistical tools will be analyzed separately. First, a literature review was conducted to account for the following three research questions:
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- What are the main definitions and causes of hospital readmissions?
- What are the consequences of this problem regarding patients, nursing, and healthcare as a whole?
- How to measure the effectiveness of potential interventions associated with discharge planning and follow-up?
By searching through databases such as MEDLINE, Cochrane, Medcom, and others and filtering through articles (150 initially), the research ended up with twenty studies that were examined in greater detail.
Literature Review Results
In terms of the first research question, it was found that key causes of hospital readmissions were associated with common comorbidities such as infections, heart failure, gastrointestinal and liver disorders, as well as neoplasms (Donzé, Lipsitz, Bates, & Schnipper, 2013). The mean age of readmitted patients was 52.9 years, while 48% of them were male (Felix, Seaberg, Bursac, Thostenson, & Stewart, 2015). Also, it is essential to note that only 22% of readmitted patients had the same diagnosis as the initial one (Lagoe, Drapola, Nanno, & Littau, 2017), which points to the fact that patients developed new conditions while being hospitalized. There were indications to the development of complex interventions for the identified demographics of patients instead of simple ones in order to enhance patients’ ability to care for themselves after discharge (Leppin et al., 2014).
When answering the second question through the review of the literature, most researchers (Donzé et al., 2013; Felix et al., 2015; Lagoe et al., 2017) indicated that readmissions present a significant challenge to healthcare professionals and reduce the quality of patients’ lives. In addition, financial penalties that account for the additional treatment of patients present a burden to the health care system overall (Fonarow & Yancy, 2017). The financial aspect is of special importance because it affects nurses, patients, and healthcare as a whole. This happens due to the limited abilities of hospitals with high readmission rates to provide care for vulnerable populations or invest in nurses’ training (Fonarow & Yancy, 2017). These results point to the need for establishing cohesive strategies for preventing readmissions and avoiding the adverse influence it has on multiple stakeholders involved in the delivery of care.
The third research question also was answered with the help of experimental intervention. The review of available studies served as a preliminary tool to identify how scholars measured the effectiveness of different programs targeted at eliminating or reducing the occurrence of hospital readmissions. The findings of the literature review include mentions of such strategies as telephone support or home-visiting and transitional care interventions as effective in positively influencing the reduction of readmissions (Feltner et al., 2014; Verhaegh et al., 2014). Since demographic factors such as age, gender, or race do not have any impact on the occurrence of hospital readmissions (Dharmarajan et al., 2013), effective interventions such as high-intensity programs could be applied to the majority of patients.
The intervention that included home-visiting programs and structured telephone support was implemented after the review of the literature. Because the examined studies suggested that readmissions were not dependent on population demographics but rather the quality of care provided to patients, the researchers included a diverse sample to verify other conclusions. In total, ten nurses were involved in the project and were responsible for measuring significant data pertinent to thirty study participants. This means that each nurse guided three post-discharge patients. In terms of patients’ demographics, twenty-one participants were female, and nine were male. In the female group, 10 participants were aged between 18 and 30 years old, while the remaining 11 were aged between 31 and 60. In the male group, 3 participants were aged between 18 and 30 years, while 9 were aged between 31 and 60. Of the thirty participants, 13 were white, 7 were African-American, 4 were Hispanic, 4 were of Chinese origin, while 2 were of other ethnic backgrounds.
After the implementation of the interventions, several results should be reported. The initial step implied home visits from nurses who educated patients on the effective strategies of self-care to avoid common comorbidities (Table 1). Based on this step, the following results were acquired:
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|n of cases post-discharge (out of 30 patients)||Mean||Gender||Age||Ethnicity/Race|
|Infections||3||16.5||1 male; 2 female||all aged 18-30||1 white; 1 Hispanic; 1 African-American|
|Gastrointestinal disorder||2||16||Male and female||18-30; 31-60.||White; Hispanic|
Table 1. The first stage of the intervention.
After the implementation of the second part – structured telephone support to aid in patients’ post-discharge recovery, the number of complications and readmissions decreased. It should be taken into account that those patients who were visited by nurses and developed complications did not participate in the second phase of the intervention due to the need for immediate readmissions (Table 2). The results of the structured telephone support stage are illustrated below:
|n of cases post-discharge (out of 24 patients)||Mean||Gender||Age||Ethnicity/Race|
Table 2. The second stage of the intervention.
As seen from the table above, in the second phase of the intervention, only three patients who got complications were readmitted to a hospital. This means that out of thirty participants in total, twenty-one remained in good health and followed the advice of their nurses correctly to avoid readmissions. However, it is important to account for the fact that nine participants have still developed post-discharge complications, possibly because of their poor health initially or the lack of adherence to the advice of their nurses.
Research Limitations and Improvement for Future Studies
Based on the findings, it can be concluded that the study had a limited study sample due to the unavailability of nurses who could have participated in the project. There were also some time constraints in terms of the professionals’ workload – some of them had to perform their usual duties at healthcare facilities and could not spend hours on home visits and telephone support. Also, there were some issues with the adherence to nurses’ recommendations, which limited the effectiveness of the intervention. To improve research capabilities on the same topic in the future, it is important to dedicate more time to search for a larger number of nurses to participate in research. This will allow selecting a wider sample of patients and take into account some time constraints and workload issues that healthcare professionals had to manage during the project. Also, the literature review as a qualitative tool may not be needed in future studies on the same topic.
Dharmarajan, K., Hsieh, A., Lin, Z., Bueno, H., Ross, J., & Horwitz, L., … Krumholz, H. M. (2013). Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA, 309(4), 355.
Donzé, J., Lipsitz, S., Bates, D., & Schnipper, J. (2013). Causes and patterns of readmissions in patients with common comorbidities: Retrospective cohort study. BMJ, 347, 1-12.
Felix, H. C., Seaberg, B., Bursac, Z., Thostenson, J., & Stewart, M. K. (2015). Why do patients keep coming back? Results of a readmitted patient survey. Social Work in Health Care, 54(1), 1-15.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z.-J., Sueta, C. A., Coker-Schwimmer, E. J. L., … Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure. Annals of Internal Medicine, 160(11), 774-785.
Fonarow, G., & Yancy, C. (2017). Consequences of reductions in hospital readmissions. JAMA, 318(19), 1933-1934.
Lagoe, R., Drapola, B., Nanno, D., & Littau, S. (2017). Causes of hospital readmissions at the community level. International Journal of Clinical Medicine, 8, 248-256.
Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., … Montori, V. M. (2014). Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107.
Verhaegh, K., MacNeil-Vroomen, J., Eslami, S., Geerlings, S., de Rooij, S., & Buurman, B. (2014). Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Affairs, 33(9), 1531-1539.