Classification and Assessment of Medication Risk in the Elderly (CARE): Use of a Medication Risk Score to Inform Patients’ Readmission Likelihood after Hospital Discharge

Abstract

Existing risk tools that identify patients at high risk of medication-related iatrogenesis are not sufficient to holistically evaluate a patient’s entire medication regimen. This study used a novel medication risk score (MRS) which holistically evaluates medication regimens and provides actionable solutions. The main purpose of this study was to quantify adults ≥ 65 years with a high medication risk burden using the MRS and secondarily, appraise MRS association with hospital readmission. This retrospective cohort study included all consecutive patients in a 6-month period aged 65 years and older, admitted for at least 48 h, and prescribed at least five medications upon discharge. Out of 3017 patients screened, 1386 met all criteria. The primary outcome was the proportion of patients with a score of ≥ 20 and the secondary outcome was the 30-day readmission rate. In the overall population, 17% of patients had an MRS ≥ 20. For patients discharged home, there was a 19% readmission rate for a score ≥ 20 and 11% for <20 (p = 0.009). A score of ≥ 20 was associated with a 1.8-fold increased risk of readmission in patients discharged home. Only 7% of patients met these criteria, which can help direct future use of the MRS at patients with the highest risk of medication-related iatrogenesis.

Assessing the Impact of an Advanced Clinical Decision Support System on Medication Safety and Hospital Readmissions in an Innovative Transitional Care Model: A Pilot Study

“…To reach statistical significance, our study should have needed 323 subjects. They are also consistent with another study that demonstrated an association between reduced MRS values and hospitalizations [14].…”

“…To date, others have validated that an elevated MRS is associated with several negative outcomes, which include ADEs, emergency department visits, hospitalizations, medical expenditures, and mortality [12,13]. Regarding readmission, San Filippo et al found that the MRS can preemptively identify patients at the highest risk of hospital readmission within 30 days post discharge [14]. Nevertheless, it is unknown whether the MRS can help pharmacists identify relevant MRPs during the transition from hospital to home, which could help reduce readmissions.…”

Cross‐sectional evaluation of a clinical decision support tool to identify medication‐related problems at discharge from the acute care setting

“…20 Patients with an MRS score of 20 or higher exhibited a 1.8-fold increased risk of 30-day readmission when discharged home. 20 The increased risk of readmission was only seen in patients discharged to home, as opposed to a skilled nursing facility or long-term care facility. 20 Among the 1386 patients included in this study, 98 (7.1%) were discharged home with a high-risk score over 6 months.…”

“…20 Among the 1386 patients included in this study, 98 (7.1%) were discharged home with a high-risk score over 6 months. 20 These data highlight the potential of the MRS as a tool to identify a manageable subset of high-risk hospital inpatients at an elevated risk of 30-day readmission, thereby enabling targeted efforts during TOC. This cross-sectional analysis aims to quantitatively assess and describe the interventions identified by pharmacists using the MRS-CDSS.…”

“…20 The increased risk of readmission was only seen in patients discharged to home, as opposed to a skilled nursing facility or long-term care facility. 20 Among the 1386 patients included in this study, 98 (7.1%) were discharged home with a high-risk score over 6 months. 20 These data highlight the potential of the MRS as a tool to identify a manageable subset of high-risk hospital inpatients at an elevated risk of 30-day readmission, thereby enabling targeted efforts during TOC.…”