Marzinski S, Melrose D, Hook M. Differing perspectives: Research on reasons for heart failure readmission. Research podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Research podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.
Background/Introduction: Heart failure is a staggering clinical and public health problem with a trajectory often associated with readmission. Previous research suggests that patients and clinicians have different perspectives about causes and preventability of readmission, with findings focused on subjective reports without clinical context.
Purpose: To gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day heart failure readmission. To evaluate responses in context with clinical data to gain insights to improve care.
Method: A convergent parallel mixed methods design was used including brief investigator-designed guided interviews and an electronic health record chart review to gather contextual information from both hospital stays. Subjects included decisional adults readmitted within 30 days of a previous inpatient stay with coded diagnosis of heart failure and their associated caregiver, attending physician, and assigned nurse. Enrollment occurred intermittently over two years (2019-2021) due to COVID-19 restrictions.
Results: Interviews were conducted with consenting patients (N=44), caregivers (n=6), physicians (n=24) and nurses (n=44). Readmissions were emergent (95%) and occurred an average of 14.9 days (8.1 SD, 2-28 days) after discharge. Patients reported symptom-based readmission reasons and. 14 (32%) thought their readmission was preventable. Physicians reported diagnoses-based reasons, with 38% as preventable. Nurses often reported behavioral reasons and 59% considered readmission preventable. Agreement between the patient, nurse, and physician on reason for readmission occurred in only 30% of cases, predicted by patient marital status (p=0.04). Most patients had high illness severity, multiple co-morbidities, and complex treatment regimens without documented heart failure stage.
Discussion: Perceptions about reasons and preventability of readmission are varied and influenced by the training and perspective of participants. Future care must consider context and need for tailored symptom management. Limitations include single site and small sample.
Implications: Understanding the context and trajectory of heart failure may help improve shared understanding of status, care planning, and outcomes.