Effect of Medication Adherence and Early Follow-Up on Unplanned Readmission Post-Myocardial Infarction: Quality Improvement in a Safety Net Hospital

Abstract

Medication nonadherence is a strong predictor of adverse events and unplanned 30-day readmissions in post-myocardial infarction (MI) patients. Nonadherence with dual antiplatelet therapy (DAPT) is of particular concern in post-MI patients, given the high rate of percutaneous coronary intervention in this population. Review of post-MI quality measures revealed that compared to national benchmarks, our safety net hospital had lower DAPT adherence rates and higher unplanned 30-day readmission rates. The aim was to improve these important quality measures by creating a transition of care pathway primarily focused on medication accessibility and affordability of DAPT and early follow-up. A multidisciplinary task force created a transition of care pathway that included bedside medication delivery, patient assistance program enrollment for medications, and follow-up within 10 days of discharge in a dedicated post-MI clinic. Resources for the pathway (personnel and hospital) were already available and repurposed. We compared quality measures of DAPT adherence, proportion of patients evaluated early after hospital discharge, and unplanned 30-day readmissions before and after the initiative. Following initiation of the transition of care pathway, DAPT adherence increased from 56% pre-intervention to 92% post-intervention (P < 0.0001). The proportion of patients scheduled for early clinic followup after discharge increased and unplanned 30-day readmissions decreased following initiation of the pathway. A transition of care pathway for post-MI patients using readily available resources was associated with increased DAPT adherence and decreased 30-day unplanned readmissions.

Development of an interdisciplinary early rheumatoid arthritis care pathway

“…Care pathways can improve patient outcomes and reduce unwarranted variation in care. There are many examples of successful care pathway implementation which have led to improvements in care processes and patient outcomes including: in gout management [ 13 ], cardiology [ 14 , 15 ], nephrology [ 16 ], and fracture management [ 17 ], to name a few. In Alberta, Canada, physicians have access to care pathways for common conditions and rapid telephone advice for additional support through Specialist Link [ 18 , 19 ].…”