Complex determinants of hospital discharge readiness among patients with acute myocardial infarction: A fuzzy-set qualitative comparative analysis

Background: Hospital discharge readiness is a crucial concept, influenced by various individual, interpersonal, and institutional factors in populations experiencing acute myocardial infarction. However, there is a gap in the exploration of these interactive variables, particularly regarding integrated configurations that facilitate readiness for hospital discharge. Objective: This study aimed to explore the complex determinants affecting hospital discharge readiness from an integrated perspective, based on the Middle-Range Theory of Adaptation to Chronic Illness. Methods: A cross-sectional observational study was conducted from July 2021 to March 2024 at a tertiary hospital in Shanghai, China. The study assessed individual demographics, family dynamics, quality of discharge teaching, adaptive capacity, and hospital discharge readiness among post-acute myocardial infarction patients. Fuzzy-set qualitative comparative analysis was employed by performing necessity and sufficiency analyses of discharge readiness. Results: A total of 240 patients participated in this study. The findings indicated that no single determinant independently achieved hospital discharge readiness. Six configurations or pathways leading to high readiness were identified, classified into three patient types: (i) hospital-driven, (ii) family-hospital-driven, and (iii) individual-family-hospital joint-driven. Among these, the most significant configuration involved high family dynamics, high quality of teaching prior to discharge, high adaptive capacity, and low-income levels. Substitutability was observed between income levels and family functions across two configurations. Conclusion: Hospital discharge readiness among post-acute myocardial infarction patients arises from interactions of multiple determinants spanning individual, interpersonal, and institutional levels. These insights can inform healthcare providers to prioritize identifying these factors and developing personalized interventions that enhance adaptive capacity, family dynamics, and teaching quality during transitional care.