Introduction
Obtaining professional medical help implies positive health outcomes and the possibility of being discharged after completing a treatment plan. However, there are cases when patients return to hospitals and require additional assessment, which results in increased care expenses and source utilization. During the last several years, the impact of the coronavirus pandemic on hospital readmission has been critical: 9% of discharged patients were readmitted to the same hospital within the last 60 days, and about 1.6% were readmitted more than once (Kuehn, 2020). Researchers and healthcare providers share their common interest in defining the ways to reduce hospital readmission ratings to improve care quality and reduce care costs (Henke et al., 2016). Many administrative and pharmacological strategies have been offered to reduce readmissions through drug reconciliation, discharged interactions, and patient education (Warchol et al., 2019). This literature review aims to identify the current state of affairs related to hospital readmissions and compare several studies in terms of their research questions, methods, and findings to define further recommendations in the field.
Research Questions
One of the major factors of the study’s success is creating an effective research question. It is not enough to ask why hospital readmissions occur or what can be done. Henke et al. (2016) examine if there is a correlation between the quality of hospital discharge planning and readmissions. Ma et al. (2017) and Blecker et al. (2018) develop their studies to identify the characteristics of patients who are at risk of hospital readmission, including home health care (HHC) patients, and the differences in their clinical conditions. Compared to previous studies, Chawla et al. (2018) choose a specific research question about the impact of HIV infections on readmissions, and Kuehn (2020) answers if COVID-19 increases discharged patients’ risks. Addressing the financial aspects of health care, Hefner et al. (2021) and Upadhyay et al. (2019) find out the influence of the financial performance of care quality and readmission rates in American hospitals. Finally, applying electronic health records and evaluating patients’ health needs become the major questions in the study by Warchol et al. (2019). The offered sources create a solid research plan within the preferred context.
Sample Populations
The researchers used different methods and sample populations to answer similar research questions about hospital readmissions. Most studies were based on systematic reviews between January 2000 and December 2018 (Hefner et al., 2021; Henke et al., 2016; Ma et al., 2017). Researchers chose about 20 articles from three to four databases for analysis, while Henke et al. (2016) analyzed data from 4,279 hospitals registered in the Healthcare Cost and Utilization Project, State Inpatient Databases. Kuehn (2020) mentioned recent findings in the field related to the pandemic modifications, with no clear samples and methods. Retrospective cohort studies include the evaluation of 3547 patients from Kamuzu Central Hospital in Lilongwe, Malawi, by Chawla et al. (2018) and 47,288,961 hospitalizations in the United States mentioned by Blecker et al. (2018). Upadhyay et al. (2019) introduced the longitudinal study to examine readmissions in 98 hospitals, while Warchol et al. (2019) interviewed 15 hospital leaders for their qualitative case study. This comparison proves that any research design can be effective for discussing hospital readmissions.
Study Limitations
Despite the intention to cover as much information as possible, most researchers admit that their studies have certain limitations to be improved in further projects. Systematic reviews by Hefner et al. (2021), Ma et al. (2017), and Henke et al. (2016) are limited to search terms or databases efficacy and the ability to identify the required number of definitions and patient-care provider relationships. Warchol et al. (2019) and Upadhyay et al. (2019) admit their limitations in the generalizability of the chosen samples and endogeneity of the original studies because all participants came from the same geographical areas. Retrospective projects by Blecker et al. (2018) and Chawla et al. (2018) do not share a clear understanding of care quality markers, which leads to poor interpretation of their studies. Compared to these studies, the limitations in Kuehn’s article (2020) remain unclear because of the nature of the chosen project. Small changes and unstable risk factors cannot be properly recognized in all these projects, requiring further work in the field.
Conclusion and Recommendations
Depending on the chosen research questions and methods, each group of researchers offers their recommendations for further improvements and detailed examination. Warchol et al. (2019) as well as Chawla et al. (2018), and Kuehn (2020) underline the necessity of exploring readmission reduction strategies in specific areas. Hefner et al. (2021) recommend developing more qualitative studies to compare different samples. Blecker et al. (2018), Henke et al. (2016), Ma et al. (2017), and Upadhyay et al. (2019) share similar ideas to expand datasets and try other methods to examine the effects of readmission rates on care quality. All these limitations and recommendations do not prove the weaknesses or mistakes but underline the strengths of research and critical thinking.
Conclusion
This literature review generally shows what has been found about hospital readmissions during the last decade and what expectations modern researchers want to underline. Certain risks can make populations vulnerable to various internal and external factors when a person is discharged. Therefore, it is important to investigate the topics, expand geographical areas, and learn what modifications and interventions to offer with available resources and knowledge gaps.
References
Blecker, S., Herrin, J., Kwon, J. Y., Grady, J. N., Jones, S., & Horwitz, L. I. (2018). Effect of hospital readmission reduction on patients at low, medium, and high risk of readmission in the Medicare population. Journal of Hospital Medicine, 13(8), 537-543. Web.
Chawla, K. S., Rosenberg, N. E., Stanley, C., Matoga, M., Maluwa, A., Kanyama, C., Ngoma, J., & Hosseinipour, M. C. (2018). HIV and early hospital readmission: Evaluation of a tertiary medical facility in Lilongwe, Malawi. BMC Health Services Research, 18(1), 1-9. Web.
Hefner, J. L., Hogan, T. H., Opoku-Agyeman, W., & Menachemi, N. (2021). Defining safety net hospitals in the health services research literature: A systematic review and critical appraisal. BMC Health Services Research, 21(1), 1-8. Web.
Henke, R. M., Karaca, Z., Jackson, P., Marder, W. D., & Wong, H. S. (2017). Discharge planning and hospital readmissions. Medical Care Research and Review, 74(3), 345-368. Web.
Kuehn, B. M. (2020). Hospital readmission is common among COVID-19 survivors. JAMA, 324(24), 2477-2477. Web.
Ma, C., Shang, J., Miner, S., Lennox, L., & Squires, A. (2018). The prevalence, reasons, and risk factors for hospital readmissions among home health care patients: A systematic review. Home Health Care Management & Practice, 30(2), 83-92. Web.
Upadhyay, Stephenson, S., A. L., & Smith, D. G. (2019). Readmission costs as well as the influence of theirs on the monetary effectiveness of healthcare facilities: A research study of Washington healthcare facilities. Inquiry, 56. Web.
Warchol, S.J., Monestim, J. P., Mayer, R. W., & Chien, W. W. (2019). Techniques to lessen healthcare facility readmission fees in a non-Medicaid expansion state. Perspectives in Health Information Management, 16. Web.