Ni Weiyi, Colayco Danielle, Hashimoto Jonathan, Komoto Kevin, Gowda Chandrakala, Wearda Bruce, McCombs Jeffrey
Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA
Synergy Pharmacy Solutions, Bakersfield, CA.
Am J Health Syst Pharm. 2018 May 15;75(10):613-621. doi: 10.2146/ajhp170255. Epub 2018 Apr 12.
Results of an evaluation of the impact of a pharmacy-based transitional care program on healthcare costs in a population of high-risk patients are reported.
A nonrandomized, observational cohort study was conducted to compare cost outcomes in a group of patients discharged from a single hospital who were referred to an ambulatory care pharmacy-based transitions-of-care (TOC) program and a control group of patients discharged from neighboring hospitals who received usual care; all patients were members of the same managed Medicaid plan. The intervention and control groups were matched by number of hospitalizations during the 180 days preceding the index admission and by index admission length of stay. In the intervention group, all matched patients referred for TOC services (including those who did not qualify for services, could not be contacted, or declined services) were included in an intent-to-treat analysis. Thirty- and 180-day inpatient, outpatient, prescription, emergency room, and total costs were analyzed by ordinary least-squares and generalized linear model regressions, with selected costs further analyzed using two-part regression models.
Among 830 patients referred to the TOC program, total healthcare costs at 180 days after discharge were an average of $2,139 lower than costs in the control group, yielding estimated savings of nearly $1.8 million for the managed care plan.
Compared with usual postdischarge care, use of TOC services was associated with a significant reduction in 180-day total healthcare costs.
报告一项基于药房的过渡性护理计划对高危患者群体医疗费用影响的评估结果。
开展了一项非随机观察性队列研究，以比较一组从单一医院出院并被转介至基于门诊护理药房的护理过渡（TOC）计划的患者与一组从邻近医院出院并接受常规护理的对照组患者的费用结果；所有患者均为同一项管理式医疗补助计划的成员。干预组和对照组根据指数入院前180天内的住院次数以及指数住院的住院时长进行匹配。在干预组中，所有被转介接受TOC服务的匹配患者（包括那些不符合服务资格、无法联系或拒绝服务的患者）均纳入意向性分析。通过普通最小二乘法和广义线性模型回归分析30天和180天的住院、门诊、处方、急诊室费用及总费用，部分选定费用使用两部分回归模型进一步分析。
在830名被转介至TOC计划的患者中，出院后180天的总医疗费用平均比对照组低2139美元，为管理式医疗计划节省了近180万美元。
与常规出院后护理相比，使用TOC服务与180天总医疗费用的显著降低相关。
