Pharmacy and Care Management Collaboration to Improve Health Outcomes through Medication Reconciliation Program Expansion

Abstracts from the Kaiser Permanente2018 National Quality Conference


Bryan Davis, PharmD

From Washington

Background: Pharmacy and Care Management departments formed a collaboration to expand Kaiser Permanente Washington’s (KPWA’s) medication reconciliation program from approximately 4700 medication reconciliations per year to a target of more than 17,000 medication reconciliations per year because of a new Centers for Medicare and Medicaid Services 5-Star measure: Medication Reconciliation Postdischarge (MRP). Medication reconciliation has been shown to decrease adverse medication events and has demonstrated potential impact on hospital readmissions. Health and safety outcomes were followed for 6 months to evaluate the program’s expansion impact.
Methods: Population: All KPWA Medicare patients. Intervention: KPWA expanded the medication reconciliation program to all Medicare patients as compared with the original program, which only served “high-risk” patients determined by an internal modified LACE (length of stay, admission, comorbidities, Emergency Department visits in last 6 months) risk stratification tool. Comparison: Baseline measures from prior years. Outcome measures: Program impact will be measured by observing readmission data as it pertains to the Healthcare Effectiveness Data and Information Set (HEDIS) Plan All-cause Readmission (PCR) measure described as an O/E ratio (observed/expected readmission ratio). Two Tableau (Seattle, WA) dashboards were built to track the percentage of successful medication reconciliations and to track trends in the O/E ratio that include analyses of patients who have received medication reconciliation.
Results: Initial analysis suggests a correlation between increased successful medication reconciliations and decreased O/E ratio. Successful medication reconciliation increased from a baseline average of about 35% of all Medicare patients to approximately 70% of all Medicare patients during a 3-month timespan. During this 3-month period, the overall O/E ratio decreased 0.15 for all Medicare patients who received medication reconciliation. Evaluating a specific population that had not received postdischarge medication reconciliation in years prior (Medicare patients deemed as “moderate-risk” for readmission), an overall decrease of 0.56 was observed in the O/E ratio (0.44 decrease from year before); and an overall decrease of 0.03 was observed regardless of medication reconciliation, indicating minimal impact because of other process changes.
Discussion: Several variables can have contributions when it comes to evaluating impact on readmissions; however, the timing of the program expansion and the decrease in O/E ratio postulates a direct impact. Readmission data will continue to be followed to confirm the observed trends. The collaboration between pharmacists, care management nurses, home health clinicians, and primary care providers has shown a positive impact on health outcomes and allows for multiple perspectives to identify problems that provides a more holistic and patient-centered focus. This program highlights how medication reconciliation can be successfully leveraged across multiple providers and should be considered across KP programs.

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