Background Medication discrepancies at care transitions are common and lead to patient harm. Medication reconciliation is a strategy to reduce this risk. Objectives To summarize available evidence on medication reconciliation interventions in the hospital setting and identify the most effective practices. Data Sources Medline (1966 through February 2012) and hand search of article bibliographies. Study Selection 26 controlled studies. Data Extraction Data were extracted on study design, setting, participants, inclusion/exclusion criteria, intervention components, timing, comparison group, outcomes, and results. Data Synthesis Studies were grouped by type of medication reconciliation intervention: pharmacist-related, information technology (IT), or other, and assigned quality ratings utilizing U.S. Preventative Services Task Force criteria. Results 15 of 26 studies reported on pharmacist-related interventions, 6 evaluated IT interventions, and 5 studied other interventions. 6 studies were classified as good quality. The comparison group for all studies was usual care, with no direct comparisons of different types of interventions. Studies consistently demonstrated a reduction in medication discrepancies (17/17 studies), potential adverse drug events (5/6 studies), and adverse drug events (2/3 studies), but showed inconsistent reduction in post-discharge healthcare utilization (improvement in 2/8 studies). Key aspects of successful interventions included intensive pharmacy staff involvement and targeting the intervention to a ‘high-risk’ patient population. Conclusions There is a paucity of rigorously designed studies comparing different inpatient medication reconciliation practices and their effects on clinical outcomes. Available evidence supports medication reconciliation interventions that heavily utilize pharmacy staff and focus on patients at high-risk for adverse events. Higher quality studies are needed to determine the most effective approaches to inpatient medication reconciliation.

BackgroundInter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied.ObjectiveTo evaluate the association between IHT and healthcare utilisation and clinical outcomes.DesignRetrospective cohort.SettingCMS 2013 100 % Master Beneficiary Summary and Inpatient claims files merged with 2013 American Hospital Association data.ParticipantsBeneficiaries≥age 65 enrolled in Medicare A and B, with an acute care hospitalisation claim in 2013 and 1 of 15 top disease categories.Main outcome measuresCost of hospitalisation, length of stay (LOS) (of entire hospitalisation), discharge home, 3 -day and 30- day mortality, in transferred vs non-transferred patients.ResultsThe final cohort consisted of 53 420 transferred patients and 53 420 propensity-score matched non-transferred patients. Across all 15 disease categories, IHT was associated with significantly higher costs, longer LOS and lower odds of discharge home. Additionally, IHT was associated with lower propensity-matched odds of 3-day and/or 30- day mortality for some disease categories (acute myocardial infarction, stroke, sepsis, respiratory disease) and higher propensity-matched odds of mortality for other disease categories (oesophageal/gastrointestinal disease, renal failure, congestive heart failure, pneumonia, renal failure, chronic obstructivepulmonary disease, hip fracture/dislocation, urinary tract infection and metabolic disease).ConclusionsIn this nationally representative study of Medicare beneficiaries, IHT was associated with higher costs, longer LOS and lower odds of discharge home, but was differentially associated with odds of early death and 30 -day mortality depending on patients’ disease category. These findings demonstrate heterogeneity among transferred patients depending on the diagnosis, presenting a nuanced assessment of this complex care transition.

In this nationally representative evaluation, we found that a sizable number of patients undergo IHT. We identified both expected and unexpected patient and hospital-level predictors of IHT, as well as unexplained variability in hospital transfer rates, suggesting lack of standardization of this complex care transition. Our study highlights further investigative avenues to help guide best practices in IHT. Journal of Hospital Medicine 2017;12:435-442.

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