2017 Resarch Forum

PHARM: M-3

Applicant & Principal Investigator: Nadia Moghim PharmD

The Impact of a meds-to-bed program on 30-day readmission rates Nadia Moghim PharmD, David Lash PharmD, Jeffrey Jolliff PharmD, Jeremiah Joson PharmD

INTRODUCTION As the healthcare paradigm shifts toward pay-for-performance models, hospitals like Kern Medical will be financially impacted based on outcomes such as 30-day readmission rates. In an attempt to reduce these rates, the Pharmacy department recently developed the Meds-to-Beds (MtB) program, which provides bedside medication delivery and pharmacist consultation to patients prior to discharge. PURPOSE To investigate the impact of a meds-to-beds program on 30-day readmission rates. METHOD We performed a retrospective cohort study of Kern Medical patients. The cohort was comprised of 200 randomly selected patients who participated in the MtB program upon discharge between 9/01/16-1/31/17 and 240 randomly selected control patients who were discharged between 9/01/15-1/31/16. Patients needed to have been discharged with at least one medication to be included in the study. Exclusion criteria included: pregnancy; age <18; deceased; discharge to hospice care; discharge to jail; leaving AMA or AWOL. Data was collected for baseline demographics, as well as several disease severity indicators (discharge location, length of stay, ICU stay, discharge diagnosis, disposition, number of medications ordered at discharge, and eGFR). The primary outcome was unplanned 30-day readmission to Kern Medical. RESULTS A total of 174 MtB patients and 170 control patients were included. There were significantly fewer 30 day readmissions in the Meds-to-Beds group (n=14, 8.0%) compared to the control group (n=28, 16.5%, P=0.02). No statistical differences in demographics (gender, age, ethnicity, insurance, and comorbidities), insurance status, length of stay, eGFR at discharge, or number of discharge medications were observed between the two groups. MtB patients had less ICU stays (13.6% versus 5.2% respectively, P=0.01) and patients were more likely to be discharged to home compared to patients in the control-arm (95.4% versus 88.8% respectively, P=0.02). Neither ICU stay nor disposition had a significant impact on 30-day readmission rates (P=0.24 and P=0.86, respectively). DISCUSSION This study has provided objective data regarding the reduction in 30-day readmission rates through the MtB program. We suspect the root-cause for the reduced readmissions to be multifactorial including enhanced discharge planning and improved patient understanding of medication regimens through bedside counseling. The possibility of confounders affecting readmissions cannot be excluded and our study was limited to readmissions to Kern Medical alone. CONCLUSIONS Through multidisciplinary collaboration during the discharge planning process, the Meds-to-Beds program decreases readmission rates and helps improve quality of care.