Category: Federal Forum Posters
Purpose: Hospital readmissions are extremely costly to the healthcare system. For this reason, the Centers for Medicare and Medicaid has focused on preventing avoidable readmission with the creation of the Hospital Readmission Reduction Program. One strategy shown to improve patient outcomes and prevent hospital readmissions is effective management of medications during transition of care. The purpose of this study was to determine if high-risk patients seen in a transitions of care (ToC) clinic have decreased 30-day readmission rates compared to those transitioning directly back to primary care through the initiation of a pilot, pharmacist-managed ToC clinic.
Methods: The Institutional Review Board approved this study completed at the Chalmers P. Wylie Veterans Affairs (VA) Ambulatory Care Center. A retrospective chart review was conducted for patients on Patient Aligned Care Teams (PACT) Yellow and Purple who were seen in the pharmacist-managed ToC clinic between October 1, 2017 and March 30, 2018. These patients were identified via clinic report provided to investigators by local pharmacy management in a Microsoft Excel spreadsheet. Patients were seen in this clinic if they met the following criteria: aged 18-100, Care Assessment Needs (CAN) score ≥ 90 indicating high risk for readmission, and discharge from a non-VA inpatient service within 14 days. The control group included randomized patients from PACT Orange and Green, admitted to a non-VA facility and matched by month of admission, with a CAN score ≥ 90. The primary outcome was comparison of 30-day readmission rates of patients seen in the ToC clinic versus those who were not. Secondary outcomes included number and type of care coordination referrals and medication-related recommendations made and accepted by a provider. It was determined that 70 patients would yield 80% power to detect a difference of 0.33 between groups for the primary outcome.
Results: Statistical evaluation is pending, thus preliminary results are described below. A total of 46 patient charts were analyzed, with 23 from each group. In regards to the primary outcome, 3 patients (13%) seen in the ToC clinic were readmitted to the hospital within 30 days of discharge, compared to 6 patients (26%) in the control group. Of note, 2 patients (66.7%) seen in the ToC clinic and 5 patients (83.3%) in the control group were readmitted for the same diagnosis. In regards to secondary outcomes, a total of 69 medication-related recommendations were made by the pharmacist to providers for patients seen in the ToC clinic. Of those 69 recommendations, 22 (31.9%) were accepted by the provider. Types of recommendations included class conversion, changed dose, inappropriate/unnecessary drug therapy, needs drug therapy, medication change due to adverse drug event, and other, with “needs drug therapy” being the most common. In addition, a total of 19 recommendations for laboratory blood work were made and 9 (47.4%) were accepted. Lastly, a total of 38 care coordination recommendations were made. Of those 38 recommendations, 19 (50%) were accepted by the provider. The most common care coordination recommendation made was referral to a physician specialist.
Conclusion: Statistical evaluation is pending, however preliminary results show this study did not meet power which limits interpretation of study results. Regardless, there were less patients readmitted within 30 days in the ToC clinic group compared to the control group. In addition, the results suggest that physicians are most likely to accept recommendations related to patients needing additional drug therapy from pharmacists, and are also open to accepting recommendations for laboratory blood work and care coordination. Larger studies that achieve power are needed in order to confirm these results.
Morgan Brauner– PGY1 Pharmacy Resident, Chalmers P. Wylie VA Ambulatory Care Center, Westerville, OH