Purpose Recent evidence suggests that improving the transitional care process may reduce 30-day readmissions and hospital length of stay (LOS). The objective of this study was to evaluate the impact of a pharmacist-led transitions-of-care (TOC) program on 30- and 90-day all-cause readmissions and LOS for patients discharged from the hospital acute care setting. Methods A retrospective cohort study was conducted using a difference-in-difference (DID) approach. Patients who were at least 18 years old with any of the following primary diagnoses were included: acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure (CHF), and pneumonia. Outcome measures were all-cause 30- and 90-day readmission and LOS for the index admission. Results From October 2013 through September 2017, 1,776 patients were discharged from the intervention site, and 2,969 patients were discharged from 3 control sites. Only 33.3% of eligible patients at the intervention site actually received the intervention. The DID analysis showed that the odds ratio (OR) for 30-day readmission was 0.65 [P = 0.035] at the intervention site following TOC program initiation. The OR for 90-day readmission was 0.75 [P = 0.070]. Among all diagnosis groups, the CHF subgroup had the highest proportion of patients who actually received the TOC intervention (57.2%). Within that CHF subgroup, the ORs for 30- and 90-day readmissions were 0.52 [P = 0.056] and 0.47 [P = 0.005], respectively. The mean LOS did not change significantly in either analysis. Conclusion This pharmacist-led transitional care intervention was associated with significantly decreased inpatient readmissions. The analysis indicates that pharmacist interventions can significantly reduce 30-day readmissions for high-risk populations and 90-day readmissions in patients with CHF.

Background: The Beers Criteria identifies potentially inappropriate medications (PIMs) that should be avoided in older adults living with dementia. Objective: The aim of this study was to provide estimates of the prevalence and persistence of PIM use among community-dwelling older adults living with dementia in 2011-2017. Methods: Medicare claims data were used to create an analytic dataset spanning from 2011 to 2017. The analysis included community-dwelling Medicare fee-for-service beneficiaries aged 65 and older who were enrolled in Medicare Part D plans, had diagnosis for dementia, and were alive for at least one calendar year. Dementia status was determined using Medicare Chronic Conditions Date Warehouse (CCW) Chronic Condition categories and Charlson Comorbidity Index. PIM use was defined as 2 or more prescription fills with at least 90 days of total days-supply in a calendar year. Descriptive statistics were used to report the prevalence and persistence of PIM use. Results: Of 1.6 million person-year observations included in the sample, 32.7% used one or more PIMs during a calendar year in 2011-2017. Breakdown by drug classes showed that 14.9% of the sample used anticholinergics, 14.0% used benzodiazepines, and 11.0% used antipsychotics. Conditional on any use, mean annual days-supply for all PIMs was 270.6 days (SD = 102.7). The mean annual days-supply for antipsychotic use was 302.7 days (SD = 131.2). Conclusion: Significant proportion of community-dwelling older adults with dementia used one or more PIMs, often for extended periods of time. The antipsychotic use in the community-dwelling older adults with dementia remains as a significant problem.

Stakeholders, including policymakers, have prioritized the need to educate nursing home (NH) staff about Alzheimer’s disease and dementia. Despite this prioritization and the relationship between staff training and outcomes, dementia-specific knowledge is variable. This study examined state-level training policies between 2011-2016. During this time 12 states (regulators and payers) implemented NH dementia training requirements, creating an opportunity for a natural experiment between states with and without new requirements. We estimated difference-in-differences models to determine the effect of state requirements on outcomes. Data from Nursing Home Compare and LTCFocus.org were linked to data on state policies. Training requirements were associated with 0.39 and 0.17 percentage point reductions in antipsychotics use and restraint use, respectively, and no impact on falls or need for help with daily activities. State requirements for dementia training in NHs are associated with a small, but significant reduction in the use of antipsychotic medication and physical restraints.

The Centers for Medicare & Medicaid Services requires nursing homes (NHs) to provide pharmacy services to ensure the safety of medication use, such as minimizing off-label medication use for residents with dementia. This study examined NH’s response to this requirement and its relationship to medication-related outcomes. The contemporaneous relationship between the quality of pharmacy services and outcome measures were modeled using facility-level longitudinal data from 2011-2017 and facility fixed-effects. The results revealed that deficiency in pharmacy services increased medication-related issues by: 11% in inappropriate medication regimen, 5% in medication error rate >5%, and 3% in any serious medication errors. Additionally, deficiency in pharmacy services was associated with small but statistically significant increases in antipsychotic use, residents with daily pain, number of hospitalizations and rehospitalization rate. The results suggest that pharmacy services have a direct and immediate impact on medication outcomes. The results underscore the importance of pharmacy services in NHs.

No abstract