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Pham H, Gangoo-Dookhan T, Hale G, Perez A, Joseph T. Impact of Student Pharmacist-Led Transition-of-Care Services on 30-Day Hospital Readmissions at a University Call Center. J Pharm Technol 2023; 39:207-211. [PMID: 37745726 PMCID: PMC10515973 DOI: 10.1177/87551225231187832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background: Transition of care (TOC) refers to the movement of patients between different health care settings due to changes in medical conditions and needs. Pharmacists can play an important role in TOC services as polypharmacy is a common reason for hospital readmission that costs the US taxpayers an average of $17 billion annually. Objective: The purpose of this study is to evaluate the impact of TOC telehealth services provided by pharmacy students at a university-based call center on 30-day hospital readmission. Methods: In this retrospective observational study, an electronic chart review was conducted for patients who were discharged from the hospital and received a telephone call from pharmacy students. Patients were referred to the pharmacy team from a primary care provider office. The co-primary endpoints were the number of 30-day all-cause hospital readmissions (including emergency department visits) and 30-day readmission due to initial admission diagnosis in patients who received a telephonic TOC call from a pharmacy student compared with patients who declined or were unable to be reached. Types of pharmacy-related TOC interventions provided by students were also collected. Results: A total of 84 patients were included in this study. All-cause 30-day readmission was similar between groups (13% vs 15.8%), whereas 30-day readmission due to initial admission diagnosis was much lower in the intervention group (5.9% vs 11.1%). Although a positive trend was observed in favor of the intervention group, a statistically significant difference was not observed for both 30-day all-cause readmission and 30-day readmission due to initial admission diagnosis. Medication reconciliation, adherence counseling, and lifestyle education (diet, exercise) are the most common topics discussed with the patients during TOC interventions. Conclusion: Using student pharmacists to provide postdischarge TOC calls can be a benefit to the patient and the health care team while offering pharmacy students valuable learning experience prior to graduation.
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Affiliation(s)
- Huy Pham
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Palm Beach Gardens, FL, USA
| | - Tricia Gangoo-Dookhan
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Davie, FL, USA
| | - Genevieve Hale
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Palm Beach Gardens, FL, USA
| | - Alexandra Perez
- Department of Sociobehavioral and Administrative Pharmacy, College of Pharmacy, Nova Southeastern University, Davie, FL, USA
| | - Tina Joseph
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Davie, FL, USA
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DeVore AD, Allen LA. A Global Challenge and a Global Opportunity for the Heart Failure Community. J Am Coll Cardiol 2023; 82:445-447. [PMID: 37495281 DOI: 10.1016/j.jacc.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Adam D DeVore
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Haddad C, Sacre H, Hallit S, Obeid S, Al-Zein D, Nabout R, Zoghbi M, Haddad G. Prevalence of comorbidities and correlates of hospital readmission rate in patients with acute mania: A one-year retrospective data from a tertiary care. Perspect Psychiatr Care 2020; 56:753-759. [PMID: 31828814 DOI: 10.1111/ppc.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/24/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the prevalence of medical comorbidities in acute manic patients over a period of 1 year, and to evaluate correlates of the readmission rate. DESIGN/METHODS A retrospective observational study was conducted on 158 acute manic patients from 2016 to 2017. RESULTS The most common physical comorbidity was obesity (36.1%) followed by cardiovascular disorders (15.2%) and liver dysfunctions (9.3%). Male gender was associated with higher readmission rate (Beta = -0.260), while taking anticholinergic drugs (Beta = -0.338) and having a family history of psychiatric disorders (Beta = -0.222) were associated with lower readmission rate. PRACTICAL IMPLICATIONS The study results may help physicians and other clinicians understand the burden of illness recurrence in bipolar disorder type I patients and adopt effective strategies to prevent relapse, taking into account all comorbidities.
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Affiliation(s)
- Chadia Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Department of Psychology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Darine Al-Zein
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Rita Nabout
- Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
| | - Marouan Zoghbi
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Department of Family Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Georges Haddad
- Departments of Research, Psychology and Psychiatry, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Medicine and Medicine Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Department of Life and Earth Sciences, Faculty of Sciences II, Lebanese University, Beirut, Lebanon
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Hernandez AF, DeVore AD. Evolving the Hospital Readmissions Reduction Program: A Call for Peace, Happiness, and Improved Patient-Centered Outcomes. J Am Coll Cardiol 2019; 74:235-7. [PMID: 31296296 DOI: 10.1016/j.jacc.2019.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022]
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Warchol SJ, Monestime JP, Mayer RW, Chien WW. Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspect Health Inf Manag 2019; 16:1a. [PMID: 31423116 PMCID: PMC6669363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
On October 1, 2012, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services began to reduce payments to hospitals with excessive rehospitalization rates through the Hospital Readmissions Reduction Program. These financial penalties have intensified hospital leaders' efforts to implement strategies to reduce readmission rates. The purpose of this multiple case study was to explore organizational strategies that leaders use to reduce readmission rates in hospitals located in a non-Medicaid-expansion state. The data collection included semistructured interviews with 15 hospital leaders located in five metropolitan and rural hospitals in southwest Missouri. Consistent with prior research, the use of predictive analytics stratified by patient population was acknowledged as a key strategy to help reduce avoidable rehospitalization. Study findings suggest that leveraging data from the electronic health records to identify at-risk patients provides comprehensive health information to reduce readmissions. Hospital leaders also revealed the need to understand and address the health needs of their local population, including social determinants such as lack of access to transportation as well as food and housing.
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Plakogiannis R, Mola A, Sinha S, Stefanidis A, Oh H, Katz S. Impact of Pharmacy Student-Driven Postdischarge Telephone Calls on Heart Failure Hospital Readmission Rates: A Pilot Program. Hosp Pharm 2018; 54:100-104. [PMID: 30923402 DOI: 10.1177/0018578718769243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Heart failure (HF) hospitalization rates have remained high in the past 10 years. Numerous studies have shown significant improvement in HF readmission rates when pharmacists or pharmacy residents conduct postdischarge telephone calls. Objective: The purpose of this retrospective review of a pilot program was to evaluate the impact of pharmacy student-driven postdischarge phone calls on 30- and 90-day hospital readmission rates in patients recently discharged with HF. Methods: A retrospective manual chart review was conducted for all patients who received a telephone call from the pharmacy students. The primary endpoint compared historical readmissions, 30 and 90 days prior to hospital discharge, with 30 and 90 days post discharge readmissions. For the secondary endpoints, historical and postdischarge 30-day and 90-day readmission rates were compared for patients with a primary diagnosis of HF and for patients with a secondary diagnosis of HF. Descriptive statistics were calculated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Results: Statistically significant decrease was observed for both the 30-day (P = .006) and 90-day (P = .007) readmission periods. Prior to the pharmacy students' phone calls, the overall group of 131 patients had historical readmission rates of 24.43% within 30 days and 38.17% within 90 days after hospital discharge. After the postdischarge phone calls, the readmission rates decreased to 11.45%, for 30 days, and 22.90%, for 90 days. Conclusion: Postdischarge phone calls, specifically made by pharmacy students, demonstrated a positive impact on reducing HF-associated hospital readmissions, adding to the growing body of evidence of different methods of pharmacy interventions and highlighting the clinical impact pharmacy students may have in transition of care services.
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Affiliation(s)
- Roda Plakogiannis
- Arnold & Marie Schwartz College of Pharmacy, Brooklyn, NY, USA.,NYU Langone Health, New York City, USA
| | - Ana Mola
- NYU Langone Health, New York City, USA
| | | | | | - Hannah Oh
- Arnold & Marie Schwartz College of Pharmacy, Brooklyn, NY, USA
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Vognar L, Mujahid N. Healthcare transitions of older adults: an overview for the general practitioner. R I Med J (2013) 2014; 98:15-18. [PMID: 25830167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Healthcare transition refers to the care "hand-off" of a patient among providers and treatment settings. Older adults experience more frequent care transitions than younger patients due to the presence of co-morbidities, cognitive impairment, increased dependence and medication use. Hospitalization and subsequent readmission after discharge to a nursing home represents a unique care transition situation. It is estimated that as many as 60% of readmissions from nursing homes can be avoided. Poor communication between hospital and nursing home staff; delayed, inaccurate, or missing discharge summaries; lack of accurate medication reconciliation; pending test results; inappropriate follow-up; and poor education of patient and families all contribute to poor care transition quality, and increase the probability of rehospitalization. Interventions for improved care transitions are suggested. They focus on patient and family-centered care effectiveness, minimizing adverse events, and increasing timely, accurate and complete communication.
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Affiliation(s)
- Lidia Vognar
- Staff Geriatrician at Providence VAMC, Assistant Professor of Medicine, Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University
| | - Nadia Mujahid
- Assistant Professor of Medicine, Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University
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Stefan MS, Pekow PS, Nsa W, Priya A, Miller LE, Bratzler DW, Rothberg MB, Goldberg RJ, Baus K, Lindenauer PK. Hospital performance measures and 30-day readmission rates. J Gen Intern Med 2013; 28:377-85. [PMID: 23070655 PMCID: PMC3579957 DOI: 10.1007/s11606-012-2229-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/21/2012] [Accepted: 08/31/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results. OBJECTIVE To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery. DESIGN, SETTING AND PARTICIPANTS We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims. MAIN OUTCOME MEASURE Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors. RESULTS Among patients aged ≥ 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates. CONCLUSIONS Hospitals with greater adherence to recommended care processes did not achieve meaningfully better 30-day hospital readmission rates compared to those with lower levels of performance.
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Affiliation(s)
- Mihaela S Stefan
- Division of General Internal Medicine, Baystate Medical Center, Springfield, MA, USA.
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