Colavecchia A Carmine, Putney David R, Johnson Michael L, Aparasu Rajender R
Houston Methodist Hospital, Department of Pharmacy, 6565 Fannin St., DB1-09, Houston, TX 77030, United States.
University of Houston, Department of Pharmaceutical Health Outcomes and Policy, Texas Medical Center Campus, Room 326, 1441 Moursund Street, Houston, TX 77030, United States.
Res Social Adm Pharm. 2017 Jul-Aug;13(4):857-863. doi: 10.1016/j.sapharm.2016.10.002. Epub 2016 Oct 8.
Limited research exists regarding Medication Regimen Complexity Index (MRCI) and its utility in identifying patients at risk for hospital readmission.
This study evaluates the association between discharge MRCI and 30-day rehospitalization in patients with heart failure (HF) after discharge.
The study involved a retrospective, cohort study at a large tertiary teaching facility from the University HealthSystem Consortium. The consortium database was used to identify HF patients hospitalized from January 2011 to December 2013. A 30-day readmission was defined as being readmitted to the same hospital within 30 days of discharge with a principal discharge diagnosis of HF. Index hospitalizations was defined as the first hospitalization, and readmission was the subsequent hospitalization for HF. A pilot analysis was conducted to compare manual MRCI collection tool and a computerized scoring MRCI system. Multivariable logistic regression was used to examine the association of computerized MRCI (≥15) and 30-day rehospitalization after controlling for other variables.
A total of 1,452 patients were included in the study with 81 patients (5.9%) readmitted within 30 days of discharge. The manual and computerized MRCIs were correlated with an R of 0.74 and R of 0.55. The multivariate logistic regression analysis found computerized MRCI ≥15 (OR: 1.62; 95% CI: 1.01-2.59) was associated with 30-day rehospitalization after controlling for other factors. Patients prescribed angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, were less likely (OR: 0.54; CI: 0.33-0.89) to be readmitted 30 days after discharge, and patients with coronary artery disease were more likely (OR: 1.76; CI: 1.03-3.00) to be readmitted 30 days after discharge.
The computerized MRCI score was moderately correlated with manual MRCI score. A significant association was found between computerized MRCI and 30-day HF readmission. Such predictive tools may allow pharmacists to prioritize patient care and optimize patient outcomes through medication therapy management.
关于药物治疗方案复杂性指数（MRCI）及其在识别有再次入院风险患者中的作用的研究有限。
本研究评估出院时的MRCI与心力衰竭（HF）患者出院后30天再入院之间的关联。
该研究是在大学卫生系统联盟的一家大型三级教学机构进行的一项回顾性队列研究。利用联盟数据库识别2011年1月至2013年12月期间住院的HF患者。30天再入院定义为出院后30天内再次入住同一家医院，主要出院诊断为HF。首次住院定义为索引住院，再入院为随后的HF住院。进行了一项初步分析，以比较手动MRCI收集工具和计算机化评分MRCI系统。在控制其他变量后，使用多变量逻辑回归来检验计算机化MRCI（≥15）与30天再入院之间的关联。
共有1452名患者纳入研究，其中81名患者（5.9%）在出院后30天内再次入院。手动和计算机化的MRCI的相关性分别为R = 0.74和R = 0.55。多变量逻辑回归分析发现，在控制其他因素后，计算机化MRCI≥15（比值比：1.62；95%置信区间：1.01 - 2.59）与30天再入院相关。服用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的患者出院后30天再次入院的可能性较小（比值比：0.54；置信区间：0.33 - 0.89），而患有冠状动脉疾病的患者出院后30天再次入院的可能性较大（比值比：1.76；置信区间：1.03 - 3.00）。
计算机化MRCI评分与手动MRCI评分中度相关。计算机化MRCI与30天HF再入院之间存在显著关联。此类预测工具可能使药剂师能够通过药物治疗管理对患者护理进行优先排序并优化患者治疗结果。
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