Shull Mariel T, Braitman Leonard E, Stites Shana D, DeLuca Angelo, Hauser Deborah
NYU Langone Health, New York, NY
Office of Research and Technology, Einstein Healthcare Network, Philadelphia, PA.
Am J Health Syst Pharm. 2018 May 1;75(9):e221-e230. doi: 10.2146/ajhp170287.
Results of a study to determine whether routine use of a multifaceted medication-focused intervention at a safety-net hospital was feasible and could reduce hospital readmissions in a Medicare fee-for-service population are reported.
A quality-improvement cohort study of 1,059 admissions of 667 patients at an inner-city hospital was conducted. Patients in the intervention groups received some or all components of the multifaceted "Medication REACH" intervention, with direct pharmacist involvement from admission through postdischarge aftercare. A pharmacist reconciled medications, provided patient-centered education, collaborated with healthcare providers to optimize therapy, ensured access to medications, and followed up with patients at home as needed. Rates of unplanned readmissions within 30 days of discharge in the full- and partial-intervention groups and in patients who received standard discharge care were compared.
Among patients who received the full Medication REACH intervention, 30 of 305 admissions (9.8%) resulted in unplanned readmissions within 30 days, as compared with a readmission rate of 20.4% (110 of 538 patients) among patients who received standard discharge care ( < 0.001). Linear regression modeling, with adjustments for patient age, sex, ethnicity, and case-mix index, indicated an adjusted risk difference favoring the full-intervention group of 9.4 percentage points (95% confidence interval, 4.3-14.6 percentage points; < 0.001).
Rates of 30-day readmission were substantially lower with pharmacist involvement and collaboration with other healthcare team members during patient transitions from the hospital to the home setting.
报告一项研究结果，该研究旨在确定在一家安全网医院常规使用多方面聚焦药物的干预措施是否可行，以及能否降低医疗保险按服务付费人群的医院再入院率。
对一家市中心医院667例患者的1059次入院进行了一项质量改进队列研究。干预组的患者接受了多方面“药物REACH”干预的部分或全部组成部分，药剂师从入院到出院后护理全程直接参与。药剂师核对药物，提供以患者为中心的教育，与医疗保健提供者合作优化治疗，确保药物可及，并根据需要对患者进行家访。比较了完全干预组、部分干预组和接受标准出院护理患者在出院后30天内的非计划再入院率。
在接受完整药物REACH干预的患者中，305次入院中有30次（9.8%）在30天内导致非计划再入院，而接受标准出院护理的患者再入院率为20.4%（538例患者中有110例）（P<0.001）。在对患者年龄、性别、种族和病例组合指数进行调整的线性回归模型中，调整后的风险差异显示，完全干预组比其他组低9.4个百分点（95%置信区间为4.3-14.6个百分点；P<0.001）。
在患者从医院过渡到家庭环境期间，药剂师参与并与其他医疗团队成员合作，可使30天再入院率大幅降低。
