Patient Perspectives and Values Frame and Modify the Impact of Risk Factors for Non-Routine Postdischarge Care: A Mixed-Methods Study

Background: Adult colorectal surgery patients continue to have high rates of readmissions, despite known risk factors for non-routine postdischarge care (emergency department (ED) visit or rehospitalization) and countless interventions to address these. It is unclear how the patient perspective frames and modifies the impact of these risk factors. This study aimed to explain why individual risk-factors led a patient to seek non-routine postdischarge care. Methods: This single institution prospective cohort study identified consecutive adult inpatient colorectal surgery patients from 2017-2018. We used a convergent parallel design to integrate electronic health record data with brief phone surveys and in-depth interviews to generate a “what, why, and so what” summary of findings. Findings: We enrolled 258 participants, surveyed 167, and interviewed 18. Overall, 20% were readmitted, 3% had an ED visit, 2% had an observation stay, and 75% had routine postdischarge care. Undergoing open surgery (RR 2.25, 95% CI 1.31-3.87) and reporting depressive symptoms (RR 1.85, 95% CI 1.02-3.37) were associated with an increased non-routine healthcare utilization. Whereas, each 10 miles increasing travel distance (RR 0.94, 95% CI 0.90-0.98), private insurance (RR 0.61 , 95% CI 0.40-0.93), and proactively scheduled follow-up appointments (RR 0.43, 95% CI 0.27-0.69) were protective factors. Patients with non-routine postdischarge care (26%) were less likely to report communication with their surgical team (80% vs 97%, p