reducing hospital utilization (readmissions and ed
TRANSCRIPT
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Reducing Hospital Utilization (Readmissions and ED)
Community Pharmacist Medication Reconciliation Program
9th Annual Right Care Initiative Clinical Performance Improvement Leadership SummitNovember 14th, Sierra Health Foundation, Sacramento
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Partners
Jeff Mason, MD
Rebecca Cupp, RPhLord Sarino, PharmDGloria Noell, RN
Mary Fermazin, MD& Team
Steve Chen, PharmD
Jan Hirsch, PhD
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Goal• Reduce hospital re-utilization (readmission and ER utilization) by
adding community pharmacists to the care team.Study Objective• Conduct and evaluate implementation of a community
pharmacy based medication reconciliation (PharmD_MedRec)
program for high-risk post-discharge patients. Primary Hypothesis• Proportion of patients with hospital re-utilization
(readmission and ED visits) during 30-days post hospital discharge will be lower in the PharmD_MedRec group compared to Usual Care discharge group.
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Polling Question #1:Which of the following medications at discharge
has not been shown to indicate a high risk of readmission?
A. AnticoagulantsB. AnticonvulsantsC. InsulinD. Oral hypoglycemic
agents
A B C D
25% 25%25%25%
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Presbyterian Daily Screening Reports Patients not meeting criteria
Patients at elevated risk of hospital re-utilization (admission or ED)Inclusion Criteria- Greater than Moderate Risk (LACE tool)
AND/OR- High Risk medications at discharge
AND- Age >18- Medical & surgical patients- Have phone access- English or Spanish speaking
(anticoagulants, oral anti-platelet, oral hypoglycemic, opioid analgesics, digoxin)
Exclusion Criteria- Patients with specific D/C program- Planned Readmission- Obstetrics- Hospice- Unwilling to consent
Proceed to Consent Process
SCREENING at Presbyterian Hospital*
*Presbyterian Intercommunity Hospital (PIH) – Whittier, CA
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Patients Give Consent
PharmD_MedRec240 patients
Randomization
Usual Discharge 240 patients
Information for Ralphs Pharmacist- LACE admission score- High risk medications – yes/no- Discharge order; date, site, diagnoses,
other pertinent- Patient contact information
Information for Study - LACE admission score- High risk medications – yes/no- Discharge order; date, site, diagnoses,
other pertinent
CONSENT & RANDOMIZATION at Presbyterian
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Confirmed no conflict with Medicare, per region IX CMO.
Medication Reconciliation
Complete Medication
Listing +
Other PRNIdentified problems for further Presbyterian Case Management
72 hrs post D/C notification +
weekly f-up x 2
Access medication discharge list and other relevant information
Nurse Case Manager &/or Social Worker
MTM Session Ralphs + Feedback to Presbyterian
Physician
Presbyterian
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Polling Question #2:The Community Pharmacist Medication
Reconciliation Program described today involves:
A. PharmacistsB. PhysiciansC. Nurse Care
ManagersD. All of the Above
A B C D
25% 25%25%25%
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Estimated Timeline• Funding approved UHC: 7/28/16• Contracting among parties: by January 2017• IRB submission: by December 2016• Enrollment Begins: March 2017• Last Patient Out: April 2018• Reporting: Summer 2018
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Two Lessons LearnedBefore Study Start!
• Relationships among partners… it’s complicated.
• Counting number of “discrepancies” found during medication reconciliation… it’s tricky
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Relationships Among Partners
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What is a discrepancy?
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Questions forAnyone?
Contact:Jan D. Hirsch, BS Pharm, PhDProfessor Clinical Pharmacy