Patient-reported experiences and outcomes following hospital care are associated with risk of readmission among adults with chronic health conditions.

This study quantifies the association between patient reported measures (PRMs) and readmission to inform efforts to improve hospital care. A retrospective, cross-sectional study was conducted with adults who had chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) and were admitted for acute care in a public hospital in New South Wales, Australia for any reason (n = 2394 COPD and 2476 CHF patients in 2018-2020). Patient- level survey data were linked with inpatient data for one year prior to risk-adjust outcomes and after discharge to detect all cause unplanned readmission to a public or private hospital. Ninety-day readmission rates for respondents with COPD or CHF were 17% and 19%. Crude rates for adults with COPD were highest among those who reported that hospital care and treatment helped "not at all" (28%), compared to those who responded, "to some extent" (20%) or "definitely" (15%). After accounting for patient characteristics, adults with COPD or CHF who said care and treatment didn't help at all were at twice the risk of readmission compared to those who responded that care and treatment helped "definitely" (Hazard ratio for COPD 1.97, CI: 1.17-3.32; CHF 2.07, CI 1.25-3.42). Patients who offered the most unfavourable ratings of overall care, understandable explanations, organised care, or preparedness for discharge were at a 1.5 to more than two times higher risk of readmission. Respect and dignity, effective and clear communications, and timely and coordinated care also matter. PRMs are strong predictors of readmission even after accounting for risk related to age and co-morbidities. More moderate ratings were associated with attenuation of risk, and the most positive ratings were associated with the lowest readmission rate. These results suggest that increasing each patient's positive experiences progressively reduces the risk of adults with chronic conditions returning to acute care.

Lessons From the West Africa Ebola Epidemic: A Systematic Review of Epidemiological and Social and Behavioral Science Research Priorities.

This systematic literature review compared the epidemiological (EPI) research and the qualitative social and behavioral science (SBS) research published during the West Africa Ebola virus disease (EVD) epidemic. Beginning with an initial capture of over 2000 articles, we extracted 236 EPI and 171 SBS studies to examine how disciplinary priorities affected research conducted during the EVD response, with implications for epidemic response effectiveness. Building on this research, we set forth a roadmap for the closer integration of EPI and SBS research in all aspects of epidemic preparedness and response that incorporates the lessons of the West Africa EVD outbreak. Key priorities include the following: (1) developing the capacity to systematically quantify qualitative sociocultural variables; (2) establishing interdisciplinary collaborations to improve "risk segmentation" practices; (3) creating and prepositioning qualitative indicators and composite sociocultural indexes for rapid deployment in outbreaks; (4) integrating novel systems with community resources; (5) developing new techniques for modeling social mobilization and community engagement; (6) prioritizing good data and complex analyses early in emergencies; and (7) learning from past experiences. Our findings support a program of action that situates data collection and analysis in real-time, recursive, integrated efforts to move community attitudes, behaviors, and responses into epidemiological research. We offer recommendations to improve coordinated, multidisciplinary approaches to health emergencies.