Table 2:
Characteristics of studies included in the meta-analysis (part 1 of 4)
| Study | No. of hospitals (no. teaching) | Patient age, yr | Hospital services | Diagnoses considered in avoidability assessment | Time frame, mo | Sources of information for avoidability assessment* | Factors included in determining avoidability† | Minimum no. of reviewers per readmission | Criteria for avoidable readmissions |
|---|---|---|---|---|---|---|---|---|---|
| Graham5 | 1 (0) | NR | NR | NR | 12 |  |
 |
1 | Inadequate medical management, social problems or inadequate rehabilitation |
| Popplewell6 | 1 (1) | All | M | All | 2 | |
 |
1 | Readmission avoidable with better management of index admission |
| MacDowell7 | 1 (1) | NR | M, S | All (non-psychiatric) | 3 |  |
|
3 | Unplanned, not a complication of chronic disease that caused index admission and not due to new disease |
| McInness8 | 1 (0) | > 65 | G | All (non-surgical) | 3 | |
|
1 | Included groups from study by Graham5: inadequate medical management, social problems or inadequate rehabilitation |
| Williams9 | 1 (0) | > 65 | All | NR | 1 |  |
 |
1 | Readmission avoidable with better preparation and timing of discharge, help for carer, communication with GP, nursing and social supports, and management of medications |
| Clarke10 | NR (NR) | NR | M, S, G | NR | 1 | |
 |
3 | Recurrence or continuation of admission diagnosis; recognized avoidable complication; or readmission for social or psychological reason within control of hospital services |
| Vinson11 | 1 (1) | > 70 | NR | CHF | 3 |  |
 |
1 | Avoidability based on degree that potentially remediable factors (noncompliance with diet/medications; inadequate discharge planning; inadequate follow-up by GP or home care; active family involvement) contributed to readmission |
| Frankl12 | 1 (1) | NR | M | NR | 1 | |
|
3 | NR |
| Kelly13 | 1 (1) | NR | NR | NR | 12 |  |
|
2 | Readmission avoidable with better treatment, rehabilitation or discharge planning |
| Gautam14 | 1 (0) | NR | G | NR | 1 |  |
 |
3 | At least two of three (GP, consultant and audit team) deemed readmission avoidable |
| Haines-Wood15 | 1 (0) | “Elderly” | R | NR | 6 |  |
|
1 | Recurrence or continuation of admission diagnosis; recognized avoidable complication; or readmission for social reason within control of hospital services |
| Oddone16 | 9 (6) | NR | M | DM, CHF, COPD | 6 |  |
 |
2 | At least two of three reviewers rated readmission avoidable |
| McKay17 | 1 (1) | NR | NR | NR | 1 | |
 |
1 | NR |
| Experton18 | 6 (NR) | > 65 | All | All | 3 | – | – | – | Administrative database study. Readmission considered possibly avoidable if adverse utilization-related factors present, including potentially premature discharge from index admission, or suboptimal care after discharge (inadequate physician follow-up care, inpatient rehabilitation, skilled nursing, home care services or other outpatient care); quantitative criteria given for each factor |
| Kwok19 | 1 (1) | ≥ 70 | M | NR | 6 |  |
|
1 | Noncompliance with medication or diet; unresolved medical problems; adverse effects of medications; social or psychological problems |
| Miles20 | 1 (1) | NR | All | NR | 1 | |
|
1 | Poor or inappropriate clinical care (i.e., ≥ 4 on 6-point scale), and preventability rated at least “more likely than not” (i.e., ≥ 4/6) |
| Levy21 | 1 (1) | NR | M | NR | 1 | |
|
1 | Consultant reviewed medical notes and judged whether readmission was potentially avoidable |
| Madigan22 | NR (NR) | NR | NR | CHF | 3 |  |
 |
1 | Avoidability based solely on opinion of treating home care nurse |
| Halfon23 | 1 (1) | All (no newborns) | All (no ophthalmology or psychiatry) | NR | 12 | |
|
1 | Premature discharge (clinical instability in last 2 days, last laboratory result was abnormal or other); missing or erroneous diagnosis or therapy; other inadequate discharge; or reviewers deemed readmission to be complication of medical care rather than natural history of disease |
| Munshi24 | 1 (1) | > 65 | M | NR | 1 | |
|
3 | Medical or social problem identified at index admission but not completely addressed; or complication of treatment |
| Sutton25 | 3 (3) | All | S | All | 1 | |
|
2 | NR |
| Courtney26 | 1 (1) | NR | S | NR | 1 | |
|
1 | NR |
| Friedman27 | NR (NR) | NR | All | All | 6 | – | – | – | Administrative database study |
| Jimenez-Puente28 | 1 (0) | NR | NR | NR | 6 | |
|
2 | Complication of surgical procedure; procedure not performed during index admission; surgery not achieving proposed objective; no diagnosis during index admission or other potentially avoidable cause (nosocomial infection, suboptimal medical treatment, unstable condition at discharge, inadequate use of drugs [wrong dosage, interaction], complication of diagnostic test, nonadherence because of inadequate information) |
| Maurer29 | 1 (1) | NR | M | NR | 3 | |
|
1 | Recurrence or continuation of index disorder; avoidable complication; or readmission for social or psychological reason within control of hospital services |
| Halfon (2006)30 | 12 (NR) | NR | NR | NR | 1 | |
|
1 | Premature discharge; wrong diagnosis or treatment; foreseeable but preventable complications of care |
| Kirk31 | 1 (0) | All | M | All | 1 | |
|
1 | Clinician reviewed medical record and interviewed patient to gauge readiness for discharge and appropriateness of readmission |
| Balla32 | 1 (1) | NR | M | NR | 1 | |
|
2 | Quality of care deemed poor because of incorrect action (erroneous drug, dose or both; diagnostic error; unnecessary test, procedure or drug) or inaction (early discharge; inadequate work-up; disregard of significant test result; failure to treat problem or monitor drug levels) |
| Goldfield33 | 234 (NR) | NR | No obstetrics, neonates | No cancer, trauma, burns or cystic fibrosis | 0.5 | – | – | – | Administrative database study |
| Ruiz34 | 1 (1) | NR | NR | NR | 2 | |
|
3 | Any adverse drug event |
| Stanley35 | 1 (0) | NR | NR | NR | 7 | |
|
1 | Any correctable factors that might have prevented the readmission |
| Witherington36 | 1 (1) | NR | NR | NR | 1 | |
|
2 | At least 2 of 3 reviewers felt readmission was related to adverse drug event from: new drug; withdrawal due to discontinuation of drug for no reason; medication that patient was supposed to stop; or condition untreated during previous admission |
| Phelan37 | 1 (1) | NR | NR | NR | 12 | |
|
2 | Deterioration of condition requiring readmission took more than 24 h and could have been managed on outpatient basis (no arrhythmia or ischemia) |
| Shalchi38 | 1 (0) | NR | NR | NR | 0.5 | |
|
3 | At least 2 of 3 reviewers felt readmission was avoidable with better management of index admission |
Note: CHF = chronic heart failure, COPD = chronic obstructive pulmonary disease, DM = diabetes mellitus, G = geriatric, GP = general practitioner, M = medical, NR = not reported, R = rehabilitation, S = surgical.
*
Each box uses the scheme at the right and represents a source of information used in the avoidability assessment: A = index admission, B = clinic visits between index admission and readmission, C = readmission, D = interviews with physician, E = interviews with patient/family.
†
Each box uses the scheme at the right and represents a factor included when determining avoidability: A = physician, B = nurse or other allied health professional, C = patient, D = social, E = system.
