Older people and hospital readmission
Research type
Research Study
Full title
“Exploring and investigating older people’s experiences and factors associated with hospital readmission: a mixed methods study”
IRAS ID
202824
Contact name
Fanis Stavrou
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
1 years, 1 months, 31 days
Research summary
The present study is a move-forward for patient-centred care and may help inform: (i) services aimed at preventing readmissions and (ii) existing predictive models of hospital readmission. A mixed methods study involving people over 65 years, who have had the experience of unplanned hospital readmission, provides the opportunity to explore and examine the main factors that matter to them. The overall aim of this mixed methods study is to explore the factors that matter the most to older people who had the experience of readmission and examine whether these factors are integrated into routinely collected hospital data. To achieve the aim and objectives of this research work, this study will be conducted in three phases. At this point of the research study, the researcher seeks ethical approval only for Phase 2.
The proposed research’s three phases are: Phase 1 - the design and development stage where with the help of the PPI (Public Participant Involvement) group a user friendly interview schedule has been developed (Ethical approval was obtained for Phase 1 ERGO ID: 25487), followed by Phase 2 - a qualitative study, using face-to-face interviews, which aims to explore older people’s experience of hospital readmission and identify factors that matter the most for people who had the experience of readmission and last Phase 3 - an analysis of the routinely collected health care data obtained from hospital. Phase 3 aims in (i) examining whether the factors indicated by the participants in phase 2 are reflected in the routinely data collected from hospital, (ii) investigating the relationship between these factors and hospital readmission and (iii) creating a descriptive profile of the sample from the hospital’s database that could help identify characteristics of people at risk of hospital readmission. Ethical approval will be obtained via IRAS for phase 2 (qualitative) and phase 3 (quantitative). The research will be reviewed by a Research Ethical Committee and a summary will be published on the Health Research Authority website following the ethical review.Summary of study results:
The qualitative interview schedule was developed and finalised with input from the PPI group in Phase 1. Four superordinate themes were identified in phase 2: ‘All about me without me’, ‘Fragmented and ad hoc post-discharge support’, ‘My readmission experience and what led me back’, and ‘Segregated health and social services that are detached from people’s needs’. The factors that mattered the most to participants in Phase 2 were mainly concerned with discharge planning and patient understanding, engagement with, and access to post-discharge resources, and formal and informal support. In phase 3, emergency admission, shorter length of stay, number of comorbidities and medication, postcode prefix, having a planned follow-up, and living alone were identified as factors that increased the likelihood of hospital readmission.
This study adds important findings on how discharge planning improves when readmitted and patients highlighted clinical and non-clinical factors such as Shared Decision Making, Activities of Daily Living, lack of physiotherapy as important to them and identified these as some of the reasons for their readmission. Non-clinical factors related to patients' everyday contexts are likely to be at least as important as clinical indicators for readmission, however, such data is not routinely collected.
REC name
East of England - Essex Research Ethics Committee
REC reference
18/EE/0152
Date of REC Opinion
18 Jun 2018
REC opinion
Further Information Favourable Opinion