Category: Professional Posters
Purpose: Post discharge medication adherence /compliance is a necessary component to avoid hospital re admissions. Centers for Medicare and Medicaid Services have reduced reimbursement for specific diagnosis's for less than 30 day readmissions, including congestive heart failure (CHF), and acute myocardial infarction (AMI) . A New England Journal of Medicine's article stated that 1 out of 5 patients are readmitted due to a patients’ failure to obtain medications post discharge. Responsively evidence-based care transitions models include pharmacy to reduce re admissions. One model, a Meds-to-beds delivery service has shown to improve care transitions by providing medications at discharge, avoiding non-compliance/ non-adherence.
Methods: The objectives of this study was to increase hospital wide utilization of the ‘Meds to Beds’ service by 20% and to evaluate the impact the program had on re admissions of CHF and AMI patients. In order to meet the objectives of this study the Pharmacy Discharge Advocate is a Registered Pharmacy Technician who collaborated with nursing teams and the retail pharmacy to facilitate the prescription delivery to the patient’s bedside at the time of discharge. As a means to improve and expand this service, the Transitions of Care Pharmacist, as part of her bedside medication counseling, offered the ‘Meds to Beds’ service to all high risk patients, including patients with a diagnosis of CHF and AMI. Patients discharged or transferred to facilities other than home and patients under the age of 18 were excluded. The pharmacy department and the transitions of care team developed educational in-services for the medical and nursing staff to heighten their awareness of the ‘Meds to Beds’ service and the positive advantages and benefits to patients. The Pharmacy Discharge Advocate was also given assistance to inform and enroll patients into the program.
Results: In calendar year 2016, there were 707 patients who enrolled in the Meds to Beds program. In 2017, a total of 937 patients utilized the program, resulting in a 32.53% increase in annual utilization. In 2017, the readmission rate for the AMI and CHF population who utilized the Meds to Beds service was 7.53% (11/175). Whereas, the readmission rate for the AMI and CHF population who didn’t utilize the ‘Meds to Beds’ service was 15.68% (135/1,017). By using the Chi-Squared test, the study results demonstrated statistical significance with a p-value = 0.0092, χ2 = 6.784, and α = 0.05.
In 2018, the number of patients enrolling in the Meds to Beds program continued to increase with 1003 patients enrolled with a 15.5% increase in the annual utilization of the program. The readmission rate for the AMI and CHF population who utilized the Meds to Beds’ service was 8.28% (12/145). The readmission rate for the AMI and CHF population who did not utilize the ‘Meds to Beds’ service was 17.15 % (172/1,003). By using the Chi-Squared test, the study results demonstrated statistical significance with a p-value = 0.0065.
Conclusion: Hospital wide utilization of the ‘Meds to Beds’ was increased by more than 20%. Also CHF and AMI patients who were enrolled were found to be half as likely to be readmitted as compared to patients not enrolled.
Under the assumption that AMI-CHF ‘Meds to Beds’ readmission rate is held constant for all AMI and CHF patients, in 2017 , 85 re admissions could have been potentially prevented resulting with a financial impact of $722,500. In 2018, 88 readmission could have been potentially prevented with savings of $748, 500 when using the CMS data of $8,500 per readmission cost .