Early readmission among patients with diabetes: a qualitative assessment of contributing factors

Abstract

Aims: To explore causes of early readmission, i.e., hospital readmission within 30 days of discharge, among patients with diabetes.

Methods: We performed thematic analysis of semi-structured interviews among 20 adults with diabetes hospitalized with an early readmission at an urban academic medical center.

Results: Five themes emerged as contributors to readmission risk: (1) poor health literacy (lack of knowledge about diabetes and discharge instructions), (2) health system failure (of the discharge process and post-discharge support), (3) failure of expected protective factors, (e.g., following the discharge instructions, being aware of medication changes upon discharge, and having help and social support), (4) social determinants of health impeding care, and (5) loss of control over illness. A majority of patients reported needing assistance with transportation, obtaining and taking medications, and preparing food. Most patients denied an active role in exacerbating their condition prior to readmission, and many believed that being readmitted was out of their control.

Conclusions: Our findings suggest several interventions that may reduce the risk of early readmission for patients with diabetes, including inpatient diabetes education, improving communication of discharge instructions, and involving patients more in medication reconciliation and post-discharge planning.

Keywords: Diabetes mellitus; Hospital discharge; Qualitative methodology; Readmissions; Thematic analysis.