Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 24;77(7):535-545.
doi: 10.1093/ajhp/zxaa012.

Real-world evidence on impact of a pharmacist-led transitional care program on 30- and 90-day readmissions after acute care episodes

Yuna H Bae-Shaaw  1 , Hyunah Eom  2 , Robert F Chun  2 , D Steven Fox  1
Affiliations

Real-world evidence on impact of a pharmacist-led transitional care program on 30- and 90-day readmissions after acute care episodes

Yuna H Bae-Shaaw et al. Am J Health Syst Pharm. .

Abstract

Purpose: Recent evidence suggests that improving the transitional care process may reduce 30-day readmissions and hospital length of stay (LOS). The objective of this study was to evaluate the impact of a pharmacist-led transitions-of-care (TOC) program on 30- and 90-day all-cause readmissions and LOS for patients discharged from the hospital acute care setting.

Methods: A retrospective cohort study was conducted using a difference-in-difference (DID) approach. Patients who were at least 18 years old with any of the following primary diagnoses were included: acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure (CHF), and pneumonia. Outcome measures were all-cause 30- and 90-day readmission and LOS for the index admission.

Results: From October 2013 through September 2017, 1,776 patients were discharged from the intervention site, and 2,969 patients were discharged from 3 control sites. Only 33.3% of eligible patients at the intervention site actually received the intervention. The DID analysis showed that the odds ratio (OR) for 30-day readmission was 0.65 [P = 0.035] at the intervention site following TOC program initiation. The OR for 90-day readmission was 0.75 [P = 0.070]. Among all diagnosis groups, the CHF subgroup had the highest proportion of patients who actually received the TOC intervention (57.2%). Within that CHF subgroup, the ORs for 30- and 90-day readmissions were 0.52 [P = 0.056] and 0.47 [P = 0.005], respectively. The mean LOS did not change significantly in either analysis.

Conclusion: This pharmacist-led transitional care intervention was associated with significantly decreased inpatient readmissions. The analysis indicates that pharmacist interventions can significantly reduce 30-day readmissions for high-risk populations and 90-day readmissions in patients with CHF.

Keywords: acute care; pharmacist-led services; readmissions; transition of care.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
CONSORT flow diagram of sample selection by site. AMA indicates against medical advice; AMI, acute myocardial infarction; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease.
Figure 2.
Figure 2.
Unadjusted 30- and 90-day readmission rates (top 2 panels) and mean length of stay (LOS) by site and year.
Figure 3.
Figure 3.
Least squares estimates (with 95% confidence intervals) from difference-in-difference analysis of changes in 30-day readmission rate (top left), 90-day readmission rate (top right), and mean length of stay (LOS), adjusted by multivariate logistic regression, from the period before to the period after implementation of the transitions-of-care (TOC) program.
See this image and copyright information in PMC

References

    1. A path to bundled payment around a rehospitalization. In: Report to the Congress: Reforming the Delivery System. Washington, DC: Medicare Payment Advisory Commission, June 2005:83-103.
    1. Van Walraven C, Bennett C, Jennings A, et al. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2001;183:E391-E402. - PMC - PubMed
    1. Burton R. Health policy brief: improving care transitions. Health Affairs.http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=76. Published September 2012. Accessed October 30, 2018.
    1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418-1428. - PubMed
    1. Centers for Medicare & Medicaid Services. Hospital Readmissions Reduction Program (HRRP).https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpat.... Accessed January 20, 2019.

Publication types