Multidisciplinary Engagement Increases Medications in-Hand for Patients Hospitalized With Asthma

Abstract

BACKGROUND: Asthma exacerbations in children are a leading cause of missed school days and health care use. Patients discharged from the hospital often do not fill discharge prescriptions and are at risk for future exacerbations.METHODS: A multidisciplinary team aimed to increase the percentage of patients discharged from the hospital after an asthma exacerbation with their medications in-hand from 15% to 80%. Tools from the model of improvement were used to establish a process map, key driver diagram, and iterative plando-study-act cycles. Statistical process control charts were used to track the proportion of patients discharged with their medications in-hand as the primary outcome. Initiating multidisciplinary daily discharge huddles on the unit was the key intervention that facilitated change in the system.RESULTS: During the study period, the percentage of patients with asthma who received their medications in-hand increased from 15% to .80% for all eligible children and .90% for children with public insurance. Children had a median age of 6.7 years, 47% were female, and 83.8% identified as non-Hispanic African American. Through iterative meetings and mapping with the multidisciplinary team, a process map for bedside delivery and a key driver diagram were created. Balancing measures, specifically length of stay and discharge medications forgotten at the hospital, remained constant.CONCLUSIONS: Improvements in increasing medication possession at the time of discharge for children hospitalized with asthma were facilitated by multidisciplinary engagement. Standardizing discharge initiatives may play a key role in improving discharge transitions for children with asthma.

Meds to Beds at Hospital Discharge Improves Medication Adherence and Readmission Rates in Select Populations

“…Many existing bedside medication delivery programs in the literature are standalone or targeted to specific populations, mainly based on readmission penalties via HRRP services and discharge diagnoses 12,21,22 . To our knowledge, this is the first study to examine whether reducing travel and financial barriers to obtaining medications reduces readmissions based on comorbidities and medical complexity, as well as primary disease diagnosis.…”

“…Many existing bedside medication delivery programs in the literature are standalone or targeted to specific populations, mainly based on readmission penalties via HRRP services and discharge diagnoses. 12,21,22 To our knowledge, this is the first study to examine whether reducing travel and financial barriers to obtaining medications reduces readmissions based on comorbidities and medical complexity, as well as primary disease diagnosis. We found that providing prescriptions and combining a subsidy to reduce financial burdens lowers readmissions compared with controls and simply providing medicines; focusing on patients with 0 or ≥ 4 comorbidities provided the greatest impact.…”