Impact of Comprehensive Medication Management on Hospital Readmission Rates

Abstract

In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort. Readmission rates also were stratified by readmission risk category. A total of 43,711 patients, contributing 57,673 hospitalizations, were included in the analysis. Of those, 1291 hospitalizations had a CMM visit within 30 days of discharge (median 6 days) and were considered the CMM cohort. Patients who received a CMM visit had a significantly lower rate of 30-day readmissions (8.6% vs. 12.8%, P < 0.001). The 60-day readmission rate remained lower among CMM patients but did not reach statistical significance (15.6% vs. 17.6%; P = 0.0528). When patients in each cohort were stratified by readmission risk category, the CMM cohort had a statistically significant lower rate of 30-day readmission in the highest risk groups (Average: 7.1% vs. 9.5%, P = 0.025; Elevated: 9.9% vs. 21.4%, P < 0.001; High: 18.3% vs. 35.9%, P < 0.001; Extreme: 36.4% vs. 77.7%, P = 0.006). CMM performed by an MTM pharmacist reduces the rate of readmission at 30 days post discharge and may have the largest impact among patients at highest risk of readmission.

Reducing Medical Admissions and Presentations Into Hospital through Optimising Medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial

“…Several pharmacist‐led interventions with the aim of averting re‐admissions by improving medicine management during the transition from hospital to primary care have been described 3,5‐11 . In most studies, hospital‐based pharmacists conducted medicine reviews and reconciliations within 14 days of hospital discharge, whether in patients’ homes, 5‐7 in an outpatient clinic, 8 or by telephone 9 .…”

Creating a Pharmacotherapy Collaborative Practice Network to Manage Medications for Children and Youth: A Population Health Perspective

“…CMM focuses on optimizing the patient’s entire drug therapy whereas disease management is centered on one disease state, such as diabetes, heart failure, asthma, and hypertension. In the case of CPAs involving children, CMM could be initiated in patients with two or more active chronic diagnoses that are managed with medications [75,76], for immunizations [77], during transitions of care from hospital to home [12,78], or when children with neurodevelopmental issues become adolescents [79,80,81,82].…”

How Comprehensive Medication Management Contributes to Foundational Elements of Primary Care

“…Prior studies have demonstrated impact on clinical measures such as A1c and diabetes-related quality measures 12 and hypertension 13 and health resource use. 14 The impact on provider 15 and patient experience is positive. 16,17 And CMM delivered as part of an interprofessional team has demonstrated a positive financial return on investment.…”

“…For example, CMM provided after hospital stays has demonstrated decreased readmissions. 14,21 Decreased readmissions are likely in part driven by coordination efforts and may be due to the support that the CMM pharmacist is providing the primary care team through coordinating with the hospital care team and may also be due to the direct contributions of the pharmacist. Last, CMM aligns with coordination through collaborating with the team, both in the primary care practice and the broader team including specialists and the patient's community pharmacy.…”