Objectives-The primary objective of this study was to evaluate the impact of a Transitions of Care (TOC) program on both all-cause and related 30-day hospital readmission. The secondary objective was to evaluate which patient-specific factors, if any, are predictive of 30-day hospital readmission.Design, setting and participants-A transitions of care program in an outpatient pharmacy, driven primarily by student pharmacists, provided telephonic counseling to recently discharged patients. The calls were conducted within two to seven days post discharge, and focused on medication counseling and reconciliation, as well as promotion of a physician follow up visit. The goal of this program was to decrease hospital readmissions among patients discharged with a cardiovascular-related diagnosis. Patient specific information was recorded in a spreadsheet, including discharge diagnosis, and readmission diagnosis for those who returned to an inpatient facility within 30 days. This study was a retrospective chart review. Data was manually extracted from the program's data spreadsheet and the institution's electronic medical record for patients referred to the transitions of care program from June through November 2017. Patients discharged to hospice, prison, or a long-term care facility were excluded from analysis. Researchers collected information on patient demographics, diagnoses and readmissions. Data analyses were performed using SAS 9.4.Outcome measures-The primary outcome measure was 30-day all-cause readmission and the secondary measure was 30-day related readmission.

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate the impact of a collaborative drug therapy management (CDTM) agreement allowing a pharmacist to automatically prescribe refills of discharge medications to patients’ preferred outpatient pharmacy on utilization of a hospital discharge prescription program and hospital readmission rates. Methods This was a single-center, quasi-experimental pre-post intervention study. Patients aged 18 years or older discharged from the cardiology services to home were eligible for inclusion in the study. The CDTM agreement was initiated on July 1, 2019. Patients discharged to home from July 1, 2018, to June 30, 2019, were assigned to the historical control group. The primary outcome was the difference in the proportion of patients who used the bedside medication delivery service at hospital discharge between the groups. Secondary outcomes included 30-day hospital readmissions and a descriptive analysis of medications prescribed by a pharmacist through the program. A χ2 test was used to assess the primary outcome, and multivariable logistic regression was used to assess hospital readmissions. Results In total, 1,704 and 2,200 patients were discharged in the control and CDTM groups, respectively. The CDTM group had a greater proportion of patients who participated in the discharge prescription program compared to the historical control group (77.8% vs 68.7%; P < 0.0001). There was no difference in 30-day hospital readmission rate between the groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.83-1.23; P = 0.94). Conclusion A CDTM protocol to improve the availability of medication refills at a patient’s regular outpatient pharmacy improved utilization of a bedside medication delivery service but did not change 30-day readmission rates.