Prevention of Early Readmissions in the Chronically Medically Ill Patient

Avoidable early hospital readmissions (30 days or fewer) in chronically medically ill patients have become a matter of importance in the U.S. healthcare system. Unexplained hospital-to-hospital variability wastes financial resources, results in Medicare/Medicaid penalties, and causes poor medical outcomes (including elevated death rates). The primary cause of this problem appears to be inadequate discharge preparation/planning. Behavioral factors, most commonly unrecognized cognitive impairment, play a significant role in early readmissions and may lead to dysadherence. Careful evaluation of psychological factors can enhance identification of the cognitively impaired patient, and permit psychoeducation of the patient/family to avoid future medical crises.