Refining interprofessional, outpatient transitions of care services to reduce hospital readmissions.
J Eval Clin Pract
; 27(2): 414-420, 2021 Apr.
Article
in En
| MEDLINE
| ID: mdl-32820591
ABSTRACT
RATIONALE, AIMS AND OBJECTIVES:
Transitions of care between healthcare facilities are associated with increased risk of adverse events and hospital readmissions. Previous studies employing pharmacists in transitions of care showed reduced 30-day readmissions, however, many were without an active comparator. There is no standardized approach to pharmacist involvement in transitions of care services, making it difficult to ascertain where pharmacist expertise is most meaningful. This paper aims to compare the 30-day hospital readmissions between an interprofessional hospital discharge visit (iHDV) with physician and pharmacist involvement to a non-interprofessional HDV (PHDV) without pharmacist involvement.METHOD:
This was a retrospective quality improvement initiative examining patients of two outpatient clinical practices within a large, academic medical centre. The primary analysis compared 30-day hospital readmission rates for patients with a scheduled PHDV or iHDV within 30-days of index hospital discharge date, regardless of attendance at the HDV. The secondary outcome compared 30-day hospital readmission rates for patients who completed a PHDV or iHDV. Primary and secondary outcomes were evaluated using bivariate analysis and multivariate analysis by stepwise logistic regression, for both intention-to-treat (ITT) and per protocol (PP).RESULTS:
This study found significantly lower 30-day hospital readmissions for patients scheduled for a PHDV compared to an iHDV (16.7% vs 21.5%, P = .0230) in an unadjusted analysis, but no significant difference in adjusted analyses (P = .4856). Per-protocol analysis found no significant difference in 30-day hospital readmission rates between groups in unadjusted and adjusted analyses. Visit completion rates were significantly different between groups, with approximately twice as many PHDV group patients completing visits as compared to the iHDV group (74.1% vs 61.5%, P < .0001).CONCLUSION:
This study demonstrates an interprofessional clinic visit employing a clinical pharmacist in the post-hospital discharge visit did not significantly reduce 30-day hospital readmission rates compared to a post-hospital discharge visit without pharmacist involvement.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Outpatients
/
Patient Readmission
Type of study:
Guideline
/
Observational_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
J Eval Clin Pract
Journal subject:
PESQUISA EM SERVICOS DE SAUDE
Year:
2021
Document type:
Article
Affiliation country:
United States