Strategies for Reducing Hospital Readmission Rates in Sulu
A Basis for Patient-centered Care Model
DOI:
https://doi.org/10.62596/cmvabs69Keywords:
hospital readmission, medical advice, patient-centered care, continuity of care, resource-limited settingsAbstract
Hospital readmissions associated with Home Against Medical Advice (HAMA) pose a significant challenge in resource-limited settings. This qualitative phenomenological study explored the strategies, challenges, and system-level barriers influencing HAMA-related readmissions in Level 1 hospitals in Sulu, Philippines. Semi-structured interviews were conducted with nine purposively selected hospital administrators and key healthcare stakeholders. Thematic analysis revealed that while hospitals employ patient preparation, follow-up monitoring, and care coordination to reduce readmissions, these strategies are frequently hindered by patient knowledge limitations, noncompliance, and severe systemic resource constraints. To address these gaps, a context-specific Patient-Centered Care Model was developed. The model integrates culturally grounded communication, structured continuous monitoring, and robust inter-facility coordination to actively mitigate systemic barriers. Implementing this model can improve discharge preparedness, strengthen patient compliance, and reduce preventable HAMA-related readmissions in geographically isolated healthcare settings.
References
Abiiro, G. A., McIntyre, D., & Meyer-Weitz, A. (2021). Healthcare provider challenges in implementing patient-centered care in low- and middle-income countries. BMC Health Services Research, 21(1), 1–12. https://doi.org/10.1186/s12913-021-06044-0
Ahmad, M., & Wilkins, S. (2024). Purposive sampling in qualitative research: A framework for the entire journey. Quality & Quantity, 1–19. DOI: https://doi.org/10.1007/s11135-024-02022-5
Alagappan, A., Chambers, T. J. G., Brown, E., Grecian, S. M., & Lockman, K. A. (2023). How does discharge against medical advice affect risk of mortality and unplanned readmission? A retrospective cohort study set in a large UK medical admissions unit. BMJ Open, 13(3), e068801. https://doi.org/10.1136/bmjopen-2022-068801 DOI: https://doi.org/10.1136/bmjopen-2022-068801
Alfandre, D., & Schumann, J. H. (2013). What is wrong with discharges against medical advice (and how to fix them). JAMA, 310(22), 2393–2394. https://doi.org/10.1001/jama.2013.280887 DOI: https://doi.org/10.1001/jama.2013.280887
Auerbach, A. D., et al. (2021). Against medical advice discharge: A narrative review and recommendations for a systematic approach. The American Journal of Medicine, 134(6), 721–726. https://doi.org/10.1016/j.amjmed.2020.12.027 DOI: https://doi.org/10.1016/j.amjmed.2020.12.027
Becker, C., Zumbrunn, S., Beck, K., Vincent, A., Loretz, N., Müller, J., … Hunziker, S. (2021). Interventions to improve communication at hospital discharge and rates of readmission: A systematic review and meta-analysis. JAMA Network Open, 4(8), e2119346. https://doi.org/10.1001/jamanetworkopen.2021.19346 DOI: https://doi.org/10.1001/jamanetworkopen.2021.19346
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., & Lavela, S. L. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research, 18(1), 168. https://doi.org/10.1186/s12913-018-2949-5 DOI: https://doi.org/10.1186/s12913-018-2949-5
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., … Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652–661. DOI: https://doi.org/10.1177/1744987120927206
Choi, M., Kim, H., Qian, H., & Palepu, A. (2011). Readmission rates of patients discharged against medical advice: A matched cohort study. PLoS ONE, 6(9), e24459. https://doi.org/10.1371/journal.pone.0024459 DOI: https://doi.org/10.1371/journal.pone.0024459
Davis, E. L., Kelly, P. J., Deane, F. P., Baker, A. L., Buckingham, M., Degan, T., & Adams, S. (2020). The relationship between patient-centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review. Substance Abuse, 41(2), 216–231. DOI: https://doi.org/10.1080/08897077.2019.1671940
Denzin, N. K. (2012). The cinematic society and the reflexive interview. Society, 49(4), 339–348. DOI: https://doi.org/10.1007/s12115-012-9558-4
Ewunetu, A., et al. (2023). Patient-centered care practice and associated factors among healthcare providers. BMC Health Services Research, 23(1), 1–11.
Glans, M., Kragh Ekstam, A., Jakobsson, U., Bondesson, Å., & Midlöv, P. (2020). Risk factors for hospital readmission in older adults within 30 days of discharge—A comparative retrospective study. BMC Geriatrics, 20, 1–12. DOI: https://doi.org/10.1186/s12877-020-01867-3
Godard-Sebillotte, C., et al. (2021). Hospital discharge planning and continuity of care: A systematic review. International Journal of Integrated Care, 21(2), 1–14.
Guo, Y., Lane, D. A., Wang, L., Zhang, H., Wang, H., Zhang, W., … Lip, G. Y. (2020). Mobile health technology to improve care for patients with atrial fibrillation. Journal of the American College of Cardiology, 75(13), 1523–1534. DOI: https://doi.org/10.1016/j.jacc.2020.01.052
Gustafsson, U., et al. (2017). Interdisciplinary communication and continuity of care in discharge planning. Journal of Interprofessional Care, 31(5), 603–610.
Jarrar, M. T., Al-Bsheish, M., Aldhmadi, B. K., Albaker, W., Meri, A., Dauwed, M., & Minai, M. S. (2021). Effect of practice environment on nurse reported quality and patient safety: The mediation role of person-centeredness. Healthcare, 9(11), 1578. DOI: https://doi.org/10.3390/healthcare9111578
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi‐structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. DOI: https://doi.org/10.1111/jan.13031
Khera, R., et al. (2022). Hospital discharge against medical advice and risk of readmission: Current evidence and healthcare implications. Journal of Hospital Medicine, 17(8), 601–609.
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158. https://doi.org/10.1186/s12912-021-00684-2 DOI: https://doi.org/10.1186/s12912-021-00684-2
Santana, M. J., et al. (2022). Patient-centered care and healthcare outcomes: A systematic review of implementation strategies. BMJ Open Quality, 11(2), e001075.
Southern, W. N., Nahvi, S., & Arnsten, J. H. (2012). Increased risk of mortality and readmission among patients discharged against medical advice. The American Journal of Medicine, 125(6), 594–602. https://doi.org/10.1016/j.amjmed.2011.12.017 DOI: https://doi.org/10.1016/j.amjmed.2011.12.017
Spooner, K. K., Saunders, J. J., Chima, C. C., Zoorob, R. J., & Salemi, J. L. (2020). Increased risk of 30-day hospital readmission among patients discharged against medical advice: A nationwide analysis. Annals of Epidemiology, 52, 77–85.e2. https://doi.org/10.1016/j.annepidem.2020.07.021 DOI: https://doi.org/10.1016/j.annepidem.2020.07.021
Tan, S. Y., Feng, J. Y., Joyce, C., Fisher, J., & Mostaghimi, A. (2020). Association of hospital discharge against medical advice with readmission and in-hospital mortality. JAMA Network Open, 3(6), e206009. https://doi.org/10.1001/jamanetworkopen.2020.6009 DOI: https://doi.org/10.1001/jamanetworkopen.2020.6009
Yu, C., Xian, Y., Jing, T., Bai, M., Li, X., Li, J., … Zhang, Z. (2023). More patient-centered care, better healthcare: The association between patient-centered care and healthcare outcomes in inpatients. Frontiers in Public Health, 11, 1148277. DOI: https://doi.org/10.3389/fpubh.2023.1148277
Downloads
Published
Issue
Section
License
Copyright (c) 2026 SOCIAL PSYCHOLOGY AND HUMAN EXPERIENCE
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
