Frequently hospitalized patients’ perceptions of factors contributing to high hospital use

Abstract

BACKGROUND: A small proportion of patients accounts for a large proportion of hospitalizations. OBJECTIVE: To obtain patients’ perspectives of factors associated with the onset and continuation of high hospital use. DESIGN: Qualitative research study where a research coordinator conducted one-on-one semi-structured interviews. A team of researchers performed inductive coding and analysis. SETTING: A single urban academic hospital. PARTICIPANTS: Patients with two unplanned 30-day readmissions within 12 months and one or more of the following: ≥1 readmission in the last six months, a referral from a clinician, or ≥3 observation visits. RESULTS: Overall, 26 participants completed the interviews. Four main themes emerged. First, major medical problems were universal, but the onset of frequent hospital use varied. Second, participants perceived fluctuations in their course to be related to psychological, social, and economic factors. Social support was perceived as helpful and participants benefited when providing social support to others. Third, episodes of illness varied in onset and generally seemed uncontrollable and often unpredictable to the participants. Fourth, participants strongly desired to avoid hospitalization and typically sought care only after self-management failed. CONCLUSIONS: Emergent themes pointed to factors which influence patients’ onset of high hospital use, fluctuations in their illness over time, and triggers to seek care during an episode of illness. These findings enable patients’ perspectives to be incorporated into the design of programs serving similar populations of frequently hospitalized patients.