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Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission

BACKGROUND: This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE: T...

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Autores principales: Segal, Jodi B., Apfel, Ariella, Brotman, Daniel J., Shermock, Kenneth M., Clark, Jeanne M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10390977/
https://www.ncbi.nlm.nih.gov/pubmed/32105180
http://dx.doi.org/10.18553/jmcp.2020.26.3.296
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author Segal, Jodi B.
Apfel, Ariella
Brotman, Daniel J.
Shermock, Kenneth M.
Clark, Jeanne M.
author_facet Segal, Jodi B.
Apfel, Ariella
Brotman, Daniel J.
Shermock, Kenneth M.
Clark, Jeanne M.
author_sort Segal, Jodi B.
collection PubMed
description BACKGROUND: This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE: To test if the intervention reduced the risk of 30-day readmission for the patients who received bedside medication delivery relative to comparable patients who did not receive bedside medication delivery. METHODS: This was a retrospective cohort study. Patients who received the intervention were linked to their claims data in the Maryland Health Information Exchange. These patients were matched on age, sex, diagnosis-related group, and hospital to a set of patients who did not receive the intervention. We used propensity score matching, as well as inverse-probability weighting, to account for residual differences between the treated and comparison patients. With robust Poisson regression, adjusting for hospital, we generated risk ratios for 30-day readmission and explored risk ratios in key subgroups. RESULTS: The cohort included 6,167 inpatients who received medications at bedside and 28,546 who did not from 10 Maryland hospitals. They were 60% female, 61% white, and 31% African American; the average age was 56 years. The risk ratio for readmission, comparing the intervention group to the propensity score-matched comparison group, was 1.21 (95% CI = 0.96-1.5). Inverse-probability weighting yielded a similar result (1.19 [95% CI = 0.98-1.45]). CONCLUSIONS: In this study, the isolated intervention of bedside medication delivery did not reduce 30-day readmission risk. We expect it may have favorable outcomes on other metrics such as primary nonadherence and patient satisfaction. It may also have a favorable effect when bundled with other care transition activities. As an isolated intervention, however, bedside medication delivery is unlikely to affect 30-day readmission rates.
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spelling pubmed-103909772023-08-02 Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission Segal, Jodi B. Apfel, Ariella Brotman, Daniel J. Shermock, Kenneth M. Clark, Jeanne M. J Manag Care Spec Pharm Research BACKGROUND: This study is an evaluation of a discharge intervention that occurred in multiple hospitals across Maryland. In this program, patients received medications at their bedside before discharge with the goal of reducing the risk of primary nonadherence to prescribed medications. OBJECTIVE: To test if the intervention reduced the risk of 30-day readmission for the patients who received bedside medication delivery relative to comparable patients who did not receive bedside medication delivery. METHODS: This was a retrospective cohort study. Patients who received the intervention were linked to their claims data in the Maryland Health Information Exchange. These patients were matched on age, sex, diagnosis-related group, and hospital to a set of patients who did not receive the intervention. We used propensity score matching, as well as inverse-probability weighting, to account for residual differences between the treated and comparison patients. With robust Poisson regression, adjusting for hospital, we generated risk ratios for 30-day readmission and explored risk ratios in key subgroups. RESULTS: The cohort included 6,167 inpatients who received medications at bedside and 28,546 who did not from 10 Maryland hospitals. They were 60% female, 61% white, and 31% African American; the average age was 56 years. The risk ratio for readmission, comparing the intervention group to the propensity score-matched comparison group, was 1.21 (95% CI = 0.96-1.5). Inverse-probability weighting yielded a similar result (1.19 [95% CI = 0.98-1.45]). CONCLUSIONS: In this study, the isolated intervention of bedside medication delivery did not reduce 30-day readmission risk. We expect it may have favorable outcomes on other metrics such as primary nonadherence and patient satisfaction. It may also have a favorable effect when bundled with other care transition activities. As an isolated intervention, however, bedside medication delivery is unlikely to affect 30-day readmission rates. Academy of Managed Care Pharmacy 2020-03 /pmc/articles/PMC10390977/ /pubmed/32105180 http://dx.doi.org/10.18553/jmcp.2020.26.3.296 Text en Copyright © 2020, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Segal, Jodi B.
Apfel, Ariella
Brotman, Daniel J.
Shermock, Kenneth M.
Clark, Jeanne M.
Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title_full Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title_fullStr Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title_full_unstemmed Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title_short Evaluation of Bedside Delivery of Medications Before Discharge: Effect on 30-Day Readmission
title_sort evaluation of bedside delivery of medications before discharge: effect on 30-day readmission
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10390977/
https://www.ncbi.nlm.nih.gov/pubmed/32105180
http://dx.doi.org/10.18553/jmcp.2020.26.3.296
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