Reasons for readmission in an underserved high-risk population: a qualitative analysis of a series of inpatient interviews

OBJECTIVE: To gather qualitative data to elucidate the reasons for readmissions in a high-risk population of underserved patients. DESIGN: We created an instrument with 27 open-ended questions based on current interventions. SETTING: Yale-New Haven Hospital. PATIENTS: Patients at the Yale Adult Primary Care Center (PCC). MEASUREMENTS: We conducted semi-structured qualitative interviews of patients who had four or more admissions in the previous 6 months and were currently readmitted to the hospital. RESULTS: We completed 17 interviews and identified themes relating to risk of readmission. We found that patients went directly to the emergency department (ED) when they experienced a change in health status without contacting their primary provider. Reasons for this included poor telephone or urgent care access and the belief that the PCC could not treat acute illness. Many patients could not name their primary provider. Conversely, every patient except one reported being able to obtain medications without undue financial burden, and every patient reported receiving adequate home care services. CONCLUSIONS: These high-risk patients were receiving the formal services that they needed, but were making the decision to go to the ED because of inadequate access to care and fragmented primary care relationships. Formal transitional care services are unlikely to be adequate in reducing readmissions without also addressing primary care access and continuity.