0
Experience
Postdischarge pharmacist medication reconciliation: Impact on readmission rates and financial savings
Meg Kilcup, PharmD; Diane Schultz, BSPharm, CPPS; Jim Carlson, PharmD; Bruce Wilson, MD
J Am Pharm Assoc (2003) 2013;53:78-84. doi:10.1331/JAPhA.2013.11250

Abstract

Objective  To assess the impact of ambulatory clinical pharmacist medication therapy assessment and reconciliation for patients postdischarge in terms of hospital readmission rates, financial savings, and medication discrepancies.

Setting  Group Health Cooperative (Group Health) in Washington State, from September 2009 through February 2010.

Practice description  Group Health is a nonprofit integrated group practice and health plan, operating 25 primary care medical centers and 5 specialty centers. Group Health's practice design is a patient-centered medical home model.

Practice innovation  All patients identified as high risk for readmission were followed by Group Health care management. Patients in care management who received a phone call from a pharmacist 3 to 7 days postdischarge for medication therapy assessment and reconciliation were identified as the medication review group (n = 243). Patients who did not receive clinical pharmacist intervention were included in the comparison group (n = 251).

Main outcome measures  Readmission rates, financial savings, and medication discrepancies.

Results  Patients who received medication therapy assessment and reconciliation had decreased readmission rates at 7, 14, and 30 days postdischarge, with statistical significance at 7 and 14 days. Medication review versus comparison readmission rates were as follows: 7 days: 0.8% vs. 4% ( P = 0.01); 14 days: 5% vs. 9% ( P = 0.04); and 30 days: 12% vs. 14% ( P = 0.29). Financial savings for Group Health per 100 patients who received medication reconciliation was an estimated $35,000, translating to more than $1,500,000 in savings annually. Of patients, 80% had at least one medication discrepancy upon discharge.

Conclusion  Most literature on medication reconciliation evaluates inpatient processes, whereas data on medication reconciliation postdischarge are limited. Our data support the hypothesis that medication assessment and reconciliation by pharmacists 3 to 7 days postdischarge can decrease readmissions and provide cost savings.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.

OR

Register for a FREE limited account to benefit from personalization features such as alerts.

References

Institute of Medicine. To err is human: building a safer health care system. Washington, DC:  National Academies Press;  2000.
 
Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138( 138): 161– 7.
 
Butterfield S, Stegel C, Glock S, Tartaglia D Understanding care transitions as a patient safety issue.www.psqh.com/mayjune-2011/838-understanding-care-transitions-as-a-patient-safety-issue.html. Accessed January 3, 2013.
 
Aufseeser-Weiss MR, Ondeck DA Medication use risk management: hospital meets home care. J Nurs Care Qual. 2001; 15( 15): 50– 7.
 
Agency for Healthcare Research and Quality. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation.www.ahrq.gov/qual/match/match.pdf. Accessed January 3, 2013.
 
Reid RJ, Fishman PA, Yu O, et al. Patient-centered medical home demonstration: a prospective, quasi-experimental before and after evaluation. Am J Manag Care. 2009; 15( 15):e 71– 87.
 
Coleman EA The Care Transitions Program.http://caretransitions.org/definitions.asp. Accessed January 3, 2013.
 
First Data Bank. Drug databases that drive patient safety.www.firstdatabank.com. Accessed November 15, 2011.
 
National Committee for Quality Assurance. HEDIS quality and measurement: adapted from HEDIS 2010 DAE-A table.www.ncqa.org/tabid/1044/Default.aspx. Accessed January 3, 2013.
 
Schuldt LM Joint Commission resources: medication reconciliation handbook.2nd rev. ed. Oakbrook Terrace, IL:  Department of Publication Joint Commission Resources;  2009: 2– 3.
 
Coleman EA, Smith JD, Raha D, et al. Post-hospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005; 165: 1842– 47.
 
Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008; 42( 42): 1373– 9.
 
Boockvar KS, Carlson LH, Giambanco V, et al. Medication reconciliation for reducing drug-discrepancy adverse events. J Am Geriatr Soc. 2006; 4( 4): 236– 43.
 
Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease re-hospitalization: a randomized trial. Ann Intern Med. 2009; 150( 150): 178– 87.
 
Koehler BE, Richter KM, Youngblood L, et al. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009; 4( 4): 211– 8.
 
Dedhia P, Kravet S, Bulger J, et al. A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes. J Am Geriatr Soc. 2009; 57( 57): 1540– 6.
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
Advertisement
 
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints