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dc.contributor.advisorMcCloskey, Loisen_US
dc.contributor.advisorFeinberg, Emilyen_US
dc.contributor.authorBhosrekar, Sarah Geesen_US
dc.date.accessioned2019-06-25T13:42:03Z
dc.date.available2019-06-25T13:42:03Z
dc.date.issued2019
dc.identifier.urihttps://hdl.handle.net/2144/36039
dc.description.abstractBACKGROUND: Individuals with serious mental illness face a significant burden of disease, yet experience lower quality care across a range of services (1). Hospital readmission within 30 days of discharge is an important, if imperfect, proxy for quality of care. Factors contributing to readmission are well documented (2–5), yet successful interventions to decrease readmissions have been slow to take shape (6–9). To effectively develop and incorporate evidence-based interventions to reduce 30-day psychiatric readmissions into large, geographically diverse inpatient systems; there is a need to conduct in-depth implementation analyses to better understand the relationship between patient-, hospital-, health system-, and community-level factors and their net impact on readmissions. This research addresses this need. METHODS: Using a modified Consolidated Framework for Implementation Research (CFIR), two state-based case studies were conducted within a large U.S. hospital system. Two hospitals per state were selected-- one with a high and one with a lower readmission rate. We conducted document reviews and semi-structured interviews (N=52) with corporate, clinical and community stakeholders, using the CFIR to identify key themes within each construct. We scored and compared hospitals with lower vs. higher readmission rates. An analysis of EMR data from the hospital system contextualized case study findings. RESULTS: In one state a complex interplay of factors at all levels contributed to readmission rates in both hospitals. In the second, constructs within the inner hospital setting contribute to differences in hospital readmission rates. Facilities with high readmission rates scored lowest among CFIR constructs “Patient Needs and Resources in the Community” and “External Policies and Incentives.” CONCLUSIONS: Ours is the first known study to explore a broad range of factors that influence readmission rates among patients with serious mental illness and a range of comorbidities. Findings from two state-based case studies indicate that readmission rates are determined by multiple, interrelated factors which vary in importance based on hospital and community context and political environment. To be effective, systemic interventions to reduce readmissions must be tailored to the specific context at targeted hospitals.en_US
dc.language.isoen_US
dc.subjectBehavioral sciencesen_US
dc.subjectBehavioral healthen_US
dc.subjectComorbiden_US
dc.subjectConsolidated framework for implementation researchen_US
dc.subjectMental illnessen_US
dc.subjectPopulation healthen_US
dc.subjectReadmissionen_US
dc.titleDeterminants of reduction in 30-day readmissions among people with a severe behavioral illness: a case studyen_US
dc.typeThesis/Dissertationen_US
dc.date.updated2019-06-04T01:06:15Z
etd.degree.nameDoctor of Public Healthen_US
etd.degree.leveldoctoralen_US
etd.degree.disciplineMaternal & Child Healthen_US
etd.degree.grantorBoston Universityen_US


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