Association between cultural factors and readmissions: The mediating effect of hospital discharge practices and care-transition preparedness

Nosaiba Rayan-Gharra, Ran D. Balicer, Boaz Tadmor, Efrat Shadmi

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)866-874
Number of pages9
JournalBMJ Quality and Safety
Volume28
Issue number11
DOIs
StatePublished - 1 Nov 2019
Externally publishedYes

Keywords

  • 30-day readmission
  • care-transition preparedness
  • cultural and linguistic factors
  • discharge practices
  • minorities

Fingerprint

Dive into the research topics of 'Association between cultural factors and readmissions: The mediating effect of hospital discharge practices and care-transition preparedness'. Together they form a unique fingerprint.

Cite this