Category: Resident Posters
Purpose: Health-system finances are directly impacted by 30-day readmissions and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The survey assesses patient’s perceptions of their care after discharge and when answered negatively, directly affects CMS reimbursement rates. Literature demonstrates poor communication and planning during transitions-of-care (TOC) leads to increased adverse drug events (ADEs) and higher hospital readmission rates. Furthermore, pharmacist’s ability to directly impact patient satisfaction through TOC services is unclear. We aimed to create a pharmacist-driven TOC pilot to improve patient satisfaction as measured by HCAHPS results and decrease 30-day hospital readmission rates.
Methods: A single-center, retrospective analysis of patients who participated in the TOC pilot at Methodist University Hospital (MUH) from 07/01/2019 – 03/31/2019 was conducted. Approval for this study was granted by the University of Tennessee Health Science Center Institutional Review Board. Included patients (INC) must have received pharmacist medication reconciliation, pharmacist education prior to discharge, and post-discharge telephone follow-up. Patients were excluded (EXC) if they did not receive all three TOC interventions. The primary outcome was to evaluate the impact of the TOC service on HCAHPS scores for “Communication about Medicines” and “Care Transitions”. Secondary outcomes evaluated included 30-day readmission rates, quantification of potential safety events prevented by the TOC pharmacist, and an assessment of the volume of discharge prescriptions sent to MUH outpatient pharmacy for TOC patients.
Results: Of the 1,728 identified patients, 1314 patients were in the EXC group (n=368 patients received only face-to-face discharge education, n=184 received only a phone call follow-up, n=762 received no interventions), leaving 414 patients in the INC group (INC=414, EXC=1314). Findings indicate a significant improvement (p=< 0.0001) in overall HCAHPS results related to “Communication about Medicines” and “Care Transitions”. Statistically significant increases for the individual questions “staff told you what the medicine was for” (p=0.018), “staff describe possible medicine side effects” (p=0.004), and “you understood the purpose of taking medications” (p=0.035) were also observed. Hospital 30-day readmission rates for the INC vs EXC groups demonstrated a non-significant decrease from 16.4% to 13.3% (p=0.133). However, an unplanned subgroup analysis evaluating the impact of a discharge phone call (discharge phone call ± in-person discharge education) on 30-day readmission rates was performed and revealed a significant reduction of 17.3% to 12.4% (p=0.007). The pilot also identified 143 patients with a medication safety event(s) that was reported as being prevented by the TOC pharmacist prior to discharge. Lastly, 562 prescriptions were captured at the academic medical center outpatient pharmacy as a direct result of the pharmacy TOC initiative creating increased health-system revenue.
Conclusion: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.