SanFilippo Savanna, Michaud Veronique, Wei Juanqin, Bikmetov Ravil, Turgeon Jacques, Brunetti Luigi
Robert Wood Johnson University Hospital Somerset, 110 Rehill Avenue, Somerville, NJ 08876, USA.
Tabula Rasa Health Care, 13845 Veteran's Way Suite 410, Lake Nona, FL 32827, USA.
J Clin Med. 2021 Aug 31;10(17):3947. doi: 10.3390/jcm10173947.
Existing risk tools that identify patients at high risk of medication-related iatrogenesis are not sufficient to holistically evaluate a patient's entire medication regimen. This study used a novel medication risk score (MRS) which holistically evaluates medication regimens and provides actionable solutions. The main purpose of this study was to quantify adults ≥ 65 years with a high medication risk burden using the MRS and secondarily, appraise MRS association with hospital readmission. This retrospective cohort study included all consecutive patients in a 6-month period aged 65 years and older, admitted for at least 48 h, and prescribed at least five medications upon discharge. Out of 3017 patients screened, 1386 met all criteria. The primary outcome was the proportion of patients with a score of ≥20 and the secondary outcome was the 30-day readmission rate. In the overall population, 17% of patients had an MRS ≥ 20. For patients discharged home, there was a 19% readmission rate for a score ≥ 20 and 11% for <20 ( = 0.009). A score of ;≥20 was associated with a 1.8-fold increased risk of readmission in patients discharged home. Only 7% of patients met these criteria, which can help direct future use of the MRS at patients with the highest risk of medication-related iatrogenesis.
现有的用于识别药物相关医源性疾病高风险患者的风险评估工具，不足以全面评估患者的整个药物治疗方案。本研究使用了一种新型药物风险评分（MRS），该评分可全面评估药物治疗方案并提供可行的解决方案。本研究的主要目的是使用MRS对65岁及以上药物风险负担高的成年人进行量化，其次是评估MRS与医院再入院的关联。这项回顾性队列研究纳入了在6个月期间内连续收治的所有65岁及以上患者，住院至少48小时，出院时至少开具了五种药物。在筛选的3017名患者中，1386名符合所有标准。主要结局是评分≥20的患者比例，次要结局是30天再入院率。在总体人群中，17%的患者MRS≥20。对于出院回家的患者，评分≥20的再入院率为19%，评分<20的再入院率为11%（P = 0.009）。评分≥20与出院回家的患者再入院风险增加1.8倍相关。只有7%的患者符合这些标准，这有助于指导未来在药物相关医源性疾病风险最高的患者中使用MRS。
