BACKGROUND Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. OBJECTIVE The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. METHODS A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. RESULTS Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). CONCLUSIONS Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

中文翻译：

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了解患者：了解复杂心力衰竭再入院的原因。

背景技术心力衰竭（HF）是一个复杂的问题，其特征是频繁住院和高30天再入院率。研究心力衰竭再入院的研究人员报告说，在未根据疾病严重程度进行调整的情况下，患者和临床医生对再入院和可预防性有不同的看法。目的 本研究的目的是收集患者、护理人员、护士和医生 30 天心力衰竭再入院的主观原因以及对可预防性的看法以及背景因素，以评估差异。方法 采用收敛、并行、混合方法设计，结合访谈和图表审查来评估当前住院时间和指数住院时间的背景因素。对上次住院后 30 天内再次入院且具有编码心力衰竭诊断的成人进行登记和访谈，随后对相关护理人员、主治医生和指定护士进行访谈。结果 对患者 (n = 44)、护理人员 (n = 6)、医生 (n = 24) 和护士 (n = 44) 进行了访谈。再入院为紧急/紧急 (95%)，平均发生在出院后 14.9 天内（SD，8.1；2-28 天）。指数停留编码显示，大多数患者 (73%) 的疾病严重程度 (73%) 和死亡风险 (68%) 较高。心力衰竭阶段的记录不一致。患者报告了急性症状原因，只有 32% 的患者表示再次入院是可以预防的。医生报告了诊断原因，其中 38% 是可以预防的。护士报告了行为原因，其中 59% 是可以预防的。患者/临床医生对再入院原因的一致性较低 (30%)。结论 对于复杂性心力衰竭患者，患者/临床医生对再入院的看法各不相同。需要根据心力衰竭分期和其他背景因素制定护理计划，以确保对疾病严重程度达成共识，并采取量身定制的症状管理方法以防止再次入院。