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



 

Bryan Davis, PharmD

https://doi.org/10.7812/TPP/18-071-22

Abstracts from the Kaiser Permanente 2018 National Quality Conference

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.

Abstracts from the Kaiser Permanente 2018 National Quality Conference

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