Reductions in 30-day readmission, mortality, and costs with inpatient-to-community pharmacist follow-up.

Abstract

OBJECTIVES\nTo determine the impact of pharmacist-provided continuous care and electronic communication on readmissions among a group of high-risk patients.\n\n\nDESIGN\nPragmatic interventional study with 5:1 matched control.\n\n\nSETTING AND PARTICIPANTS\nPatients discharged from any of 4 hospitals with chronic obstructive pulmonary disease, pneumonia, heart failure, acute myocardial infarction, or diabetes within Pennsylvania. Patients in the intervention group received consultative services from inpatient pharmacists before discharge and inpatient-to-community pharmacist communication of hospitalization information facilitated with the use of a secure messaging system. After discharge, patients received up to 5 in-person or telephonic medication management consultations with their community pharmacists.\n\n\nMAIN OUTCOME MEASURES\nThe principal end point was 30-day readmission. Secondary end points included time to event (readmission, emergency department [ED] visit, death, or composite of hospitalization, ED, or death) over 90 days after discharge. Financial feasibility and sustainability were also assessed with the use of a return-on-investment (ROI) model based on information within the subset of patients with health plan coverage.\n\n\nRESULTS\nAmong patients who received inpatient intervention plus consultation with community pharmacists compared with matched control patients, we observed a lower 30-day readmission rate (9% vs. 15%, respectively; P\xa0= 0.02), 30-day all-cause mortality (2% vs. 5%; P\xa0= 0.04), and composite 30-day end point of readmission, ED visit, or death (22% vs. 28%; P\xa0= 0.09). Differences between the groups diminished and no longer maintained statistical significance at 90 days. An estimated average ROI of 8.1 was also observed among the subset with health plan information (worst base case range 1.9-16.3).\n\n\nCONCLUSION\nConnecting community pharmacists to inpatient pharmacists during the transitional hospital-to-home time frame is feasible and resulted in lower 30-day readmissions and significant ROI, that is, significant impact on health care utilization and total health care costs. Results of this study have broad implications for improving the care of high-risk patients moving from hospital to home, most notably in the engagement of community pharmacists after discharge to assure medication use and follow-up to reduce readmissions and total costs of care.