Study Seeks to Identify Patients at Risk for Readmission

SAN DIEGO--Nursing staff at Fox Chase Cancer Center are investigating the factors that put cancer patients at risk for hospital readmission, said Carolyn Weaver, RN, MSN, AOCN, a clinical nurse specialist and patient education coordinator at the Center. Ms. Weaver explained the study in her poster presentation during the 26th Annual Conference of the Oncology Nursing Society (abstract 166).

"We were looking at the readmission rate of cancer patients into the Center and asked if there might be ways to identify why one person is more likely to be readmitted than another," she said. "Four clinical nurse specialists and our director of nursing research decided to do a research study. Basically, it’s a medical chart review to see if we could identify these criteria."

The research team developed a readmission criteria record to document potential risk factors, including age, marital status, financial status, cancer diagnosis, the reason for the initial admission and the readmission, other medical conditions, supports patients may have at home, difficulty with coping or with pain, or other unresolved issues.

"Our goal is to collect 150 patients in 1 year," Ms. Weaver said. "We’ve done a pilot study on 16 charts to achieve inter-rater reliability—that means all of us are completing the form in the same way—and we’ve made adjustments throughout that process."

The team began its data collection in March 2001 and expects to go through July 2002. They are reviewing charts of patients readmitted within 7 days of discharge and charts of patients not readmitted.

"We’ll be doing data analysis, such as Chi-square and Fisher’s exact tests, and the Mann-Whitney test to see if we can find out which criteria influenced one group to be readmitted and not the other," Ms. Weaver said.

With this information in hand, the team’s goal at the end of the process is to see if, as advanced practice nurses, they can identify those patients who will be at risk and intervene with planning and follow-up at discharge, ultimately reducing the readmission rate through care.

"Say that we find out that patients over 75 years old or patients who live alone or with a diagnosis of lung cancer are at risk for readmission, these will be red flags for us," Ms. Weaver said. "So in our role as advanced practice nurses, we’ll do whatever is needed to make sure patients have the support and education to prevent readmission."