Impact of Medication Reconciliation Programs on Reducing Readmission Rate and Enhancing Medication Safety During Transitions of Care



 

Alfonso Becerra, PharmD; Donald Yee, RPh; Karen Cham, PharmD; Sheireen Huang, PharmD; Shubhi Nagrani, PharmD; Adenola Akilo, PharmD; Karina Briones, PharmD; Kelvin Chan, PharmD; Carolyn Woo, PharmD; Chad Friday, RPh

https://doi.org/10.7812/TPP/19-039-27

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Mid-Atlantic States, Northern California

Background: Medication reconciliation upon hospital and skilled nursing facility (SNF) discharge allows for early identification of medication discrepancies and improves transitions of care, which affects hospital readmission. The Mid-Atlantic Transitional Care Clinical Pharmacy and Continuing Care Team focuses on the Comprehensive Medication Reconciliation (CMR) program for more than 35,000 members per year. Similarly, Northern California Regional Pharmacy and Continuum Teams has focused on the SNF Medication Reconciliation program for SNF patients discharged to the community. Health and safety outcomes are trended to evaluate impact.
Methods: The Kaiser Permanente (KP) Mid-Atlantic States (KPMAS) CMR program targets all patients discharged from the hospital. At discharge, hospitalized patients with a calculated LACE score (length of stay, acuity of admission, comorbidities, number of Emergency Department [ED] visits) and patients with no LACE score are tracked. This is compared with baseline measures in prior years. The outcome measure includes readmission rates. The KP Northern California (KPNC) SNF Medication Reconciliation program targets all patients discharged from 27 contracted SNFs. Medication reconciliation is provided following SNF discharge. The comparator includes baseline hospital readmission and ED visits. The outcome measures include hospital readmission and ED visits, the number of medication interventions, and intervention types (ie, adherence, omissions, etc).
Results: Medication reconciliation in both the KPMAS CMR program and KPNC SNF Medication Reconciliation showed potential impact on hospital readmission. In the KPMAS CMR program, patients with a LACE score and medication reconciliation are up to 20% less likely to be readmitted than patients without. Among discharged patients with LACE ³ 10, 16% of patients with medication reconciliation were readmitted compared with 37% of patients without medication reconciliation. In the KPNC SNF Medication Reconciliation Program, preliminary pilot results show a reduction in inpatient readmission by 4.4% and overall ED utilization rate by 11.8%. Almost 80% of SNF patients discharged had at least 1 medication intervention with an average of 3 interventions per patient. The most common intervention included gap in drug therapy followed by vaccination recommendations.
Discussion: Medication reconciliation has a positive impact on health outcomes. Both programs have demonstrated how medication reconciliation can be leveraged to facilitate transitions of care with minimal disruptions. The KPMAS Region has surpassed the regional goal of completing medication reconciliation for 95% of patients discharged from a core hospital. The Transitional Care Clinical Pharmacy and Continuing Care Teams will continue to collaborate with health care practitioners, and track readmission data. KPNC Regional Pharmacy, Continuum teams, centralized outpatient pharmacists, and contracted SNFs, have identified the need for medication interventions throughout transitions of care. This program is being implemented to the remaining approximately 50 contracted SNFs.

Abstracts from the Kaiser Permanente 2019 National Quality Conference

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