Key result
Cultural factors are linked to 30-day readmissions, mediated by hospital discharge practices and care-transition preparedness.
Why the study?
It was unknown whether hospital discharge practices and care-transition preparedness mediate the association between patients' cultural factors and readmissions.
Cohort (n=599)
No
Effect estimate: B coefficient=-0.95
p-value: p=0.021
Providing high-quality discharge planning tailored to patients' cultural characteristics is associated with better care-transition preparedness and reduced 30-day readmissions.
Discharge practices tailored to cultural factors were associated with fewer readmissions; hypothesis-generating for targeted transition interventions before changing practice.
OBJECTIVES: The study examines whether hospital discharge practices and care-transition preparedness mediate the association between patients' cultural factors and readmissions. METHODS: A prospective study of internal medicine patients (n=599) examining a culturally diverse cohort, at a tertiary medical centre in Israel. The in-hospital baseline questionnaire included sociodemographic, cultural factors (Multidimensional Health Locus of Control, family collectivism, health literacy and minority status) and physical, mental and functional health status. A follow-up telephone survey assessed hospital discharge practices: use of the teach-back method, providers' cultural competence, at-discharge language concordance and caregiver presence and care-transition preparedness using the care transition measure (CTM). Clinical and administrative data, including 30-day readmissions to any hospital, were retrieved from the healthcare organisation's data warehouse. Multiple mediation was tested using Hayes's PROCESS procedure, model 80. RESULTS: A total of 101 patients (17%) were readmitted within 30 days. Multiple logistic regressions indicated that all cultural factors, except for minority status, were associated with 30-day readmission when no mediators were included (p<0.05). Multiple mediation analysis indicated significant indirect effects of the cultural factors on readmission through the hospital discharge practices and CTM. Finally, when the mediators were included, strong direct and indirect effects between minority status and readmission were found (B coefficient=-0.95; p=0.021). CONCLUSIONS: The results show that the association between patients' cultural factors and 30-day readmission is mediated by the hospital discharge practices and care transition. Providing high-quality discharge planning tailored to patients' cultural characteristics is associated with better care-transition preparedness, which, in turn, is associated with reduced 30-day readmissions.
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Rayan‐Gharra et al. (2019) conducted a cohort in internal medicine patients (n=599). Cultural factors was evaluated on 30-day readmissions to any hospital (B coefficient=-0.95, p=0.021). Cultural factors were associated with 30-day readmission (overall rate 17%), an effect mediated by hospital discharge practices and care-transition preparedness.
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