Language, culture and preventable readmissions: pragmatic, intervention studies needed

Preventable hospital readmissions are considered a marker of care quality. Readmissions burden patients and their families and are a significant driver of healthcare costs.1 2 In the USA (where we are based), readmission penalties have resulted in an array of interventions, ranging from the relatively simple (eg, ensuring a timely follow-up appointment) to bundled interventions with multiple components (eg, medication reconciliation plus phone follow-up plus structured handoff to outpatient clinicians).3 Evaluation results, however, have been mixed and progress in reducing readmissions difficult. Studies generally have provided limited details about interventions and the patient groups involved, making it impossible to know what worked for whom.3 4 Complicating the practical implications of this research is that bundled interventions, which tend to be more successful, require greater investment of clinical and financial resources and at times result in net financial loss, significantly dampening health system enthusiasm for implementation of programmes to reduce admissions.5 Importantly, despite well-documented racial/ethnic disparities in readmission rates,6 many studies in the USA have taken a ‘one-size-fits-all’ approach by designing interventions that do not attempt to address the specific needs or circumstances of diverse populations. The study by lead author and colleagues in this issue of BMJ Quality & Safety 7 differs from much of the readmission literature in two important ways. First, the study focused on discharge practices and activities adapted for diverse populations. Working with a patient population in Israel that included a diverse groups of patients—Russian-speaking immigrants from the former Soviet Union, Arabic-speakers from several ethnic groups and Hebrew-speakers—the authors examined the association of what they termed cultural factors (eg, …