Budlong Holly, Brummel Amanda, Rhodes Adam, Nici Hannah
1 Health Outcomes, Fairview Pharmacy Services, Minneapolis, Minnesota.
2 Medication Therapy Management, Fairview Pharmacy Services, Minneapolis, Minnesota.
Popul Health Manag. 2018 Oct;21(5):395-400. doi: 10.1089/pop.2017.0167. Epub 2018 Feb 13.
In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort. Readmission rates also were stratified by readmission risk category. A total of 43,711 patients, contributing 57,673 hospitalizations, were included in the analysis. Of those, 1291 hospitalizations had a CMM visit within 30 days of discharge (median 6 days) and were considered the CMM cohort. Patients who received a CMM visit had a significantly lower rate of 30-day readmissions (8.6% vs. 12.8%, P < 0.001). The 60-day readmission rate remained lower among CMM patients but did not reach statistical significance (15.6% vs. 17.6%; P = 0.0528). When patients in each cohort were stratified by readmission risk category, the CMM cohort had a statistically significant lower rate of 30-day readmission in the highest risk groups (Average: 7.1% vs. 9.5%, P = 0.025; Elevated: 9.9% vs. 21.4%, P < 0.001; High: 18.3% vs. 35.9%, P < 0.001; Extreme: 36.4% vs. 77.7%, P = 0.006). CMM performed by an MTM pharmacist reduces the rate of readmission at 30 days post discharge and may have the largest impact among patients at highest risk of readmission.
2012年，美景健康系统实施了一项正式的护理转接流程，其中包括转介至药物治疗管理（MTM）药剂师提供的门诊服务以及其他临床服务。本分析评估了MTM提供的综合药物管理（CMM）服务对再入院率的影响。利用回顾性电子病历（EMR）数据确定2012年12月1日至2015年7月31日期间的住院情况。在CMM队列和对照队列中计算30天和60天再入院率。再入院率也按再入院风险类别分层。分析共纳入43,711例患者，涉及57,673次住院。其中，1291次住院在出院后30天内（中位数6天）接受了CMM访视，被视为CMM队列。接受CMM访视的患者30天再入院率显著较低（8.6%对12.8%，P < 0.001）。CMM患者的60天再入院率仍较低，但未达到统计学显著性（15.6%对17.6%；P = 0.0528）。当按再入院风险类别对每个队列中的患者进行分层时，CMM队列在最高风险组中的30天再入院率在统计学上显著较低（平均：7.1%对9.5%，P = 0.025；升高：9.9%对21.4%，P < 0.001；高：18.3%对35.9%，P < 0.001；极高：36.4%对77.7%，P = 0.006）。MTM药剂师进行的CMM可降低出院后30天的再入院率，并且可能对再入院风险最高的患者产生最大影响。
