CONTEXT: In the United States, approximately 5% of all patients generate > 50% of US healthcare expenditures. However, most studies of these so-called super-utilizers (SUs) have concentrated on urban underserved populations. This research uniquely focuses on an empaneled suburban population of Family Medicine patients who are super-utilizers of healthcare. Phase 1 identified common barriers SUs experienced surrounding discharge from the inpatient to the outpatient service. This second phase will focus on comparing the different perceptions that SUs and their inpatient and outpatient providers have about factors that lead to frequent readmissions. OBJECTIVES: SETTING: Family Medicine inpatient and outpatient services in a suburban academic medical center. OUTCOMES MEASURED: Alignment of themes from patient and provider interviews related to barriers to care that lead to frequent hospitalizations. EXPECTED RESULTS: We expect that some of the common themes, particularly those related to medical aspects of care (ex. discharge process, medication management, chronic disease management) that patients identify as barriers to care, will be similar to the themes that the providers identify. However, we suspect that providers may be less aware of the social aspects of care that can act as barriers of care for patients (ex. transportation and support at home).
Specific Aim 1: Identify common themes that SUs think lead to frequent readmissions.
Specific Aim 2: Identify common themes that the inpatient and outpatient providers for SUs think are factors that lead to frequent readmissions.
Specific Aim 3: Compare the themes identified by patients and their inpatient and outpatient providers to determine how they align with each other regarding the factors that lead to frequent readmission.
STUDY DESIGN: This qualitative study will focus on 30 SUs age 18 and older belonging to a Family Medicine practice of an academic medical center who have had 3 or more admissions to the Family Medicine inpatient service in a 180-day period. Semi-structured interviews will be conducted with each patient and his/her most recent inpatient provider and outpatient primary care physician. This study will use interpretive phenomenology and thematic analysis to identify and compare the common themes identified by both providers and patients regarding barriers to care that lead to frequent readmissions.
