Effects of a Hospitalwide Pharmacy Practice Model Change on Readmission Rates

Purpose

This study evaluated whether a hospitalwide, team-based pharmacy practice model could reduce 30-day hospital readmissions and return emergency department (ED) visits after discharge.

Study Design

The authors used an observational pre-post analysis at an academic medical center. They compared outcomes during a 3-month preimplementation period (July-September 2012) with a 3-month postimplementation period (October-December 2012), after the model was implemented on October 1, 2012.

Key Components of the Practice Model

• Medication reconciliation at transitions of care for every patient.
• Discharge education for a high-risk subgroup.
• New or expanded pharmacy services in the preanesthesia testing clinic and emergency department.
• A medication reconciliation technician team.
• Pharmacist-to-patient ratios of 1:30 on acute care floors and 1:18 on critical care units.

Patients and Outcomes

A total of 3,316 patients were included. The primary outcome was the composite rate of 30-day readmissions and return ED visits. Patients were also stratified into high-risk and non-high-risk groups.

Main Results

• Pharmacy teams completed medication reconciliation in 95.8% of admission cases and 69.7% of discharge cases.
• The intervention was associated with a significant decrease in 30-day readmissions for high-risk patients.
• The article conclusion states that the team-based pharmacy practice model significantly reduced 30-day readmissions in high-risk patients.
• The authors estimated potential annualized savings of about $783,450 in direct costs and $1,121,850 in total costs based on the observed reduction in readmissions among high-risk patients.

Interpretation

The findings suggest that a comprehensive, hospitalwide pharmacy practice redesign may improve transitions of care and reduce avoidable readmissions, especially for patients at highest risk. The study supports pharmacist involvement in medication reconciliation, discharge education, and team-based care.

Important Limitations and Notes

The study was observational and used a pre-post design, so causation cannot be proven as strongly as in a randomized study. The authors also noted that implementation required planning, communication, training, and ongoing process monitoring.

Bottom Line

In this AJHP practice report, implementing a hospitalwide, team-based pharmacy practice model was associated with lower 30-day readmission rates among high-risk patients and meaningful projected cost savings.