J Am Pharm Assoc (2003). 2021 Jan-Feb;61(1):95-100.e1. doi: 10.1016/j.japh.2020.09.023. Epub 2020 Nov 13.
Since the establishment of the Hospital Readmission Reduction Program by the Centers for Medicare and Medicaid Services, reducing readmission rates has been a priority for health care institutions. Many institutions have developed services to combat high readmission rates, including bedside medication delivery programs, which have demonstrated reductions in 30-day readmission rates in patients who used these services.
To evaluate the impact of health system-based bedside medication delivery programs on readmission rates in patients at a low to moderate risk of hospital readmission.
A single-center retrospective cohort study conducted on adult patients of low-to moderate-transitions of care (TOC) risk status with unplanned admissions to a large academic medical center between January 1, 2017, and January 1, 2019 who used the medication bedside delivery service or an outside pharmacy. The TOC risk status was defined using historic institutional definitions. Patients with at least a 2-day hospital stay and who were discharged to home from select primary medical services were included. The primary outcome was 30-day readmission rates between the 2 groups. Secondary outcomes included 60- and 90-day readmission rates and readmission rates stratified by primary medical service and TOC status. Coarsened exact matching was used to account for variation between groups.
The study evaluated 6583 patients discharged with a total of 3905 patients and corresponding index admissions meeting inclusion criteria for analysis. No statistically significant difference between readmission rates at 30 days after the index admission was found between the medication bedside delivery group and the outside pharmacy group, 7.97% and 10.09%, respectively (P = 0.136). However, the readmission rate of the medication bedside delivery group was statistically significantly lower than that of the outside pharmacy group at 60 and 90 days.
This study suggests that bedside medication delivery programs do not significantly reduce readmission rates at 30 days but may do so at 60 and 90 days.
自医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）建立医院再入院率降低计划以来，降低再入院率一直是医疗机构的首要任务。许多机构已经开发了服务来对抗高再入院率，包括床边用药配送服务，这些服务已证明在使用这些服务的患者中降低了 30 天再入院率。
评估基于医疗系统的床边用药配送服务对低至中度再入院风险患者的再入院率的影响。
在 2017 年 1 月 1 日至 2019 年 1 月 1 日期间，对低至中度转归风险（Transitions of Care，TOC）状态的成年患者进行了一项单中心回顾性队列研究，这些患者因计划外住院而入住大型学术医疗中心，他们使用了药物床边配送服务或外部药房。TOC 风险状态使用历史机构定义进行定义。纳入至少住院 2 天并从选定的初级医疗服务出院的患者。主要结局是两组之间 30 天的再入院率。次要结局包括 60 天和 90 天的再入院率以及按初级医疗服务和 TOC 状态分层的再入院率。粗化精确匹配用于解释组间差异。
该研究评估了 6583 名出院患者，共有 3905 名患者和相应的索引入院符合分析的纳入标准。在索引入院后 30 天，床边用药组和外部药房组的再入院率分别为 7.97%和 10.09%，差异无统计学意义（P=0.136）。然而，床边用药组的再入院率在 60 天和 90 天显著低于外部药房组。
本研究表明，床边用药配送服务在 30 天内不会显著降低再入院率，但可能会在 60 天和 90 天内降低再入院率。
