Self-Efficacy As a Determinant of Hospital Readmission in Patients with Acute Venous Thromboembolism: Preliminary Findings

Background and Purpose: Patients diagnosed with acute venous thromboembolic disease (VTE), or blood clots, are at a high risk of complications after being discharged from inpatient hospitalization. For patients with VTE, the transition from the hospital setting to the community involves following a precise regimen of anticoagulant medications (blood thinners), attending follow-up medical appointments, and ongoing communication with their care team to measure progress.

Self-efficacy, the self-perceived confidence in one’s ability to deal with health problems, has been shown to be a strong predictor of future health outcomes. While much research has been done to explore the relationship between self-efficacy and long term chronic disease management, little attention has been focused on the relationship between self-efficacy and acute disease management which can result in hospital readmission.

The purpose of this study is to explore the correlation between reported self-efficacy after hospital discharge and 30-day readmission rates in patients with VTE.

Methods: Admitted patients with the diagnoses of acute pulmonary embolism, acute deep vein thrombosis or acute VTE were identified using electronic medical record review and were recruited for the study (N=38). Patients were eligible to participate if they were being discharged home or to sub-acute rehabilitation facilities, and if they were prescribed oral or injectable anticoagulation to treat their blood clot.

Approximately one week post-discharge, patients completed an adapted version of the previously validated “Self-Efficacy for Managing Chronic Disease 6-Item Scale” in which they rate levels of confidence in managing blood clot symptoms on a Likert scale of 1 to 10. These responses were then dichotomized into low self-efficacy (0-5) and high self-efficacy (6-10). Patients reported on their ability to manage fatigue, physical discomfort, emotional distress, other health issues, and their ability to complete tasks and activities needed to manage their health. The data was analyzed using Fishers exact test due to small sample size.

Results: Of 38 patients, 6 were readmitted within 30 days of discharge (15.79%). Patients who reported high self-efficacy in managing physical discomfort (n=28) were significantly less likely to be readmitted to the hospital within 30 days (p=0.0026). Patients who reported high levels of self-efficacy in managing fatigue (n=26) were also less likely to be readmitted (p= 0.0661). There were no significant relationships found between high levels of self-efficacy in managing emotional distress, other health issues, and tasks and activities and readmission rates.

Conclusions: Self-efficacy may play a significant role in readmission risk in conjunction with the active management of VTE. Patients who believed they were in greater control of their pain and fatigue were less likely to be readmitted after returning home. Interventions that seek to increase self-efficacy should be developed to improve health outcomes in patients being discharged with acute illnesses.