Lam Simon W, Sokn Erick
Pharmacoeconomics and Outcomes Research, Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA.
Transitions of Care, Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA.
J Pharm Pract. 2020 Oct;33(5):628-632. doi: 10.1177/0897190019825961. Epub 2019 Feb 6.
Previous studies demonstrated that transitions of care bundles, which include bedside discharge medication delivery (BDMD), may be helpful in decreasing hospital readmissions.
To evaluate the effects of BDMD alone on day 30 readmission rates.
Retrospective, cohort study comparing those who received pharmacy-driven BDMD to usual discharge. Primary outcome was day 30 readmission rates. Multivariable logistic regression was used to account for baseline differences between groups.
A total of 30916 patients met inclusion and exclusion criteria. Of those, 2253 (7%) received BDMD and 28663 (93%) received usual care. Significant differences in age, distance from hospital, race, marital status, insurance type, previous hospitalizations, admission source, baseline comorbidities, and medication counts were observed between groups. Patients who received BDMD were less likely to have day 30 readmissions (10.6% vs 12.8%, = .002). However, after adjusting for baseline characteristics, BDMD was not an independent predictor of day 30 readmission (adjusted odds ratio = 0.91, 95% confidence interval = 0.79-1.04, = .17). BDMD was associated with decreased day 14 readmissions in an unadjusted analysis.
BDMD was not independently associated with a reduction in day 30 readmissions. Future studies should focus on targeting patients who are most likely to benefit from this service.
先前的研究表明，包括床边出院药物配送（BDMD）在内的护理束过渡可能有助于降低医院再入院率。
评估单独使用BDMD对30天再入院率的影响。
回顾性队列研究，比较接受药学驱动的BDMD与常规出院的患者。主要结局是30天再入院率。采用多变量逻辑回归分析来考虑组间的基线差异。
共有30916例患者符合纳入和排除标准。其中，2253例（7%）接受了BDMD，28663例（93%）接受了常规护理。两组在年龄、离医院距离、种族、婚姻状况、保险类型、既往住院史、入院来源、基线合并症和用药数量方面存在显著差异。接受BDMD的患者30天再入院的可能性较小（10.6%对12.8%，P = .002）。然而，在调整基线特征后，BDMD不是30天再入院的独立预测因素（调整后的比值比 = 0.91，95%置信区间 = 0.79 - 1.04，P = .17）。在未调整的分析中，BDMD与14天再入院率降低相关。
BDMD与30天再入院率的降低没有独立关联。未来的研究应聚焦于确定最可能从这项服务中获益的患者。
