1. Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making
- Author
-
Evan Small, Eric C. Polley, Adam P. Sawatsky, Deanne T. Kashiwagi, Lisa M. Daniels, Masashi Okubo, and Atsushi Sorita
- Subjects
Adult ,Male ,Patient Transfer ,medicine.medical_specialty ,Patient risk ,Clinical Decision-Making ,Physician Decision ,Cohort Studies ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Health care ,Internal Medicine ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,Qualitative Research ,Aged ,Original Research ,Patient factors ,Aged, 80 and over ,business.industry ,030208 emergency & critical care medicine ,Emergency department ,Length of Stay ,Middle Aged ,Case-Control Studies ,Emergency medicine ,Female ,Emergency Service, Hospital ,business ,Risk assessment ,Cohort study - Abstract
BACKGROUND: Potentially preventable admissions are a target for healthcare cost containment. OBJECTIVE: To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. DESIGN: A comparative cohort study was used to determine rates of potentially preventable admissions and to identify associated factors and patient outcomes. A qualitative case study was used to explore physicians’ clinical decision-making. PARTICIPANTS: Patients admitted from the emergency department (ED) to the general medicine (GM) service over a total of 4 weeks were included as cases (N = 401). Physicians from both emergency medicine (EM) and GM that were involved in the cases were included (N = 82). APPROACH: Physicians categorized admissions as potentially preventable. We examined differences in patient characteristics, admission characteristics, and patient outcomes between potentially preventable and control admissions. Interviews with participating physicians were conducted and transcribed. Transcriptions were systematically analyzed for key concepts regarding potentially preventable admissions. KEY RESULTS: EM and GM physicians categorized 22.2% (90/401) of admissions as potentially preventable. There were no significant differences between potentially preventable and control admissions in patient or admission characteristics. Potentially preventable admissions had shorter length of stay (2.1 vs. 3.6 days, p
- Published
- 2018