Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals

Med Care. 2012 Jul;50(7):599-605. doi: 10.1097/MLR.0b013e318249ce72.


Objective: To understand factors leading to all-cause 30-day readmissions in a community hospital population.

Research design: Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team.

Setting: Eighteen Kaiser Permanente Northern California hospitals.

Results: Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management.

Conclusions: Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Advance Care Planning / organization & administration
  • Aged
  • Aged, 80 and over
  • California
  • Continuity of Patient Care / organization & administration
  • Female
  • Hospital Administration / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Office Visits / statistics & numerical data
  • Patient Readmission / statistics & numerical data*
  • Quality Improvement / organization & administration
  • Quality of Health Care / organization & administration*
  • Quality of Health Care / statistics & numerical data*
  • Racial Groups / statistics & numerical data