Real-world evidence on impact of a pharmacist-led transitional care program on 30- and 90-day readmissions after acute care episodes

Abstract

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.

Quality measures of clinical pharmacy services during transitions of care

“…to 36.5%. 13,14,17,21,23,30,52,53,[71][72][73][74][75][76] Comprehensive admission-todischarge studies have been among the most successful. One study showed a 36.5% lower medication-related hospitalization rate by targeting an older population with a service beginning in the hospital, together with postdischarge services provided by community pharmacists.…”

“…Finally, because each additional hospital day adds to the direct costs of the index patient presentation, total hospital length of stay should be measured to show that a service has decreased the length of, or not unnecessarily prolonged, the hospitalization. 13,30,74 Maintaining regulatory accreditation status, avoiding HRRP financial penalties, and meeting core measures can also be linked with economic outcomes that pharmacists can affect. By reducing excess HCU, recent studies have indicated that comprehensive admission-topostdischarge TOC services supported annual cost savings of $780 000 to $6.6 million.…”

“…Institutional TOC services generally begin upon admission, either with a medication history or an admission medication reconciliation review, and may continue through discharge with medication education and a discharge medication reconciliation review. Recent studies have shown significant reductions in 30‐day HCU rates ranging from 4.5% to 36.5% 13,14,17,21,23,30,52,53,71‐76 . Comprehensive admission‐to‐discharge studies have been among the most successful.…”

“…Resources that augment service efficiency (eg, materials, IT [information technology] programs specific to pharmacist workflows, and other overhead costs) should also be documented. Finally, because each additional hospital day adds to the direct costs of the index patient presentation, total hospital length of stay should be measured to show that a service has decreased the length of, or not unnecessarily prolonged, the hospitalization 13,30,74 …”

Questionnaire Survey-Based Quantitative Assessment of the Impact of Transitional Care on Self-Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…The purpose of TC is to increase patient's disease self-management, promote medical stability, and decline readmission rate via telephone follow-up, home visiting, and messages. TC has been proved to improve the prognosis of patients with chronic diseases [ 8 , 9 ]. Moreover, TC can reduce medical costs by lowering emergency attendance rates and readmission rate [ 10 ].…”