Understanding Patients' Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery

Qual Health Res. 2021 Jul;31(9):1582-1595. doi: 10.1177/10497323211002479. Epub 2021 Apr 10.

Abstract

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients' high-resource health care utilization.

Keywords: Southeastern United States; behavior; caregivers; caretaking; crisis; crisis management; decision-making; determinants of health; emergency care; health; health behavior; health care; health seeking; information seeking; qualitative; users’ experiences.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aftercare
  • Colorectal Surgery*
  • Delivery of Health Care
  • Emergency Service, Hospital
  • Humans
  • Patient Discharge
  • Patient Readmission
  • Prospective Studies