Reducing Hospital Utilization (Readmissions and ED ...
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Reducing Hospital Utilization (Readmissions and ED) Community Pharmacist Medication Reconciliation Program 9th Annual Right Care Initiative Clinical Performance Improvement Leadership Summit November 14 th , Sierra Health Foundation, Sacramento
Transcript of Reducing Hospital Utilization (Readmissions and ED ...
Reducing Hospital Utilization (Readmissions and ED)
Community Pharmacist Medication Reconciliation Program
9th Annual Right Care Initiative Clinical Performance Improvement Leadership SummitNovember 14th, Sierra Health Foundation, Sacramento
Partners
Jeff Mason, MD
Rebecca Cupp, RPhLord Sarino, PharmDGloria Noell, RN
Mary Fermazin, MD& Team
Steve Chen, PharmD
Jan Hirsch, PhD
Goal• Reduce hospital re-utilization (readmission and ER utilization) by
adding community pharmacists to the care team.Study Objective• Conduct and evaluate implementation of a community
pharmacy based medication reconciliation (PharmD_MedRec)
program for high-risk post-discharge patients. Primary Hypothesis• Proportion of patients with hospital re-utilization
(readmission and ED visits) during 30-days post hospital discharge will be lower in the PharmD_MedRec group compared to Usual Care discharge group.
Polling Question #1:Which of the following medications at discharge
has not been shown to indicate a high risk of readmission?
A. AnticoagulantsB. AnticonvulsantsC. InsulinD. Oral hypoglycemic
agents
A B C D
25% 25%25%25%
Presbyterian Daily Screening Reports Patients not meeting criteria
Patients at elevated risk of hospital re-utilization (admission or ED)Inclusion Criteria- Greater than Moderate Risk (LACE tool)
AND/OR- High Risk medications at discharge
AND- Age >18- Medical & surgical patients- Have phone access- English or Spanish speaking
(anticoagulants, oral anti-platelet, oral hypoglycemic, opioid analgesics, digoxin)
Exclusion Criteria- Patients with specific D/C program- Planned Readmission- Obstetrics- Hospice- Unwilling to consent
Proceed to Consent Process
SCREENING at Presbyterian Hospital*
*Presbyterian Intercommunity Hospital (PIH) – Whittier, CA
Patients Give Consent
PharmD_MedRec240 patients
Randomization
Usual Discharge 240 patients
Information for Ralphs Pharmacist- LACE admission score- High risk medications – yes/no- Discharge order; date, site, diagnoses,
other pertinent- Patient contact information
Information for Study - LACE admission score- High risk medications – yes/no- Discharge order; date, site, diagnoses,
other pertinent
CONSENT & RANDOMIZATION at Presbyterian
Confirmed no conflict with Medicare, per region IX CMO.
Medication Reconciliation
Complete Medication
Listing +
Other PRNIdentified problems for further Presbyterian Case Management
72 hrs post D/C notification +
weekly f-up x 2
Access medication discharge list and other relevant information
Nurse Case Manager &/or Social Worker
MTM Session Ralphs + Feedback to Presbyterian
Physician
Presbyterian
Polling Question #2:The Community Pharmacist Medication
Reconciliation Program described today involves:
A. PharmacistsB. PhysiciansC. Nurse Care
ManagersD. All of the Above
A B C D
25% 25%25%25%
Estimated Timeline• Funding approved UHC: 7/28/16• Contracting among parties: by January 2017• IRB submission: by December 2016• Enrollment Begins: March 2017• Last Patient Out: April 2018• Reporting: Summer 2018
Two Lessons LearnedBefore Study Start!
• Relationships among partners… it’s complicated.
• Counting number of “discrepancies” found during medication reconciliation… it’s tricky
Relationships Among Partners
What is a discrepancy?
Questions forAnyone?
Contact:Jan D. Hirsch, BS Pharm, PhDProfessor Clinical Pharmacy
