Cargando…

The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment

BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (...

Descripción completa

Detalles Bibliográficos
Autores principales: Schumacher, Christie, Moaddab, Golbarg, Colbert, Monique, Kliethermes, Mary Ann
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397892/
https://www.ncbi.nlm.nih.gov/pubmed/30058987
http://dx.doi.org/10.18553/jmcp.2018.24.8.795
_version_ 1785083981292634112
author Schumacher, Christie
Moaddab, Golbarg
Colbert, Monique
Kliethermes, Mary Ann
author_facet Schumacher, Christie
Moaddab, Golbarg
Colbert, Monique
Kliethermes, Mary Ann
author_sort Schumacher, Christie
collection PubMed
description BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION: In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group – Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS: From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS: Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacist’s role in a team-based model of care.
format Online
Article
Text
id pubmed-10397892
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Academy of Managed Care Pharmacy
record_format MEDLINE/PubMed
spelling pubmed-103978922023-08-04 The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment Schumacher, Christie Moaddab, Golbarg Colbert, Monique Kliethermes, Mary Ann J Manag Care Spec Pharm Best Practices BACKGROUND: Recent changes in the health care delivery landscape have expanded opportunities for clinical pharmacists in the ambulatory care setting. This article describes the successful integration of a clinical pharmacist-led chronic disease management service in a patient-centered medical home (PCMH) and accountable care organization (ACO) environment. PROGRAM DESCRIPTION: In 2008, the year before PCMH implementation, 36% of patients who were hospitalized at Advocate Trinity Hospital for a heart failure exacerbation were readmitted within 30 days of their hospital stay for heart failure exacerbation. This high rate of heart failure hospital readmissions, compared with national standards, drove the implementation of the PCMH at Advocate Medical Group – Southeast Center (AMG-SE), the adjoining outpatient medical clinic. A clinical pharmacist was added to the health care team to help achieve the collective goal of improving patient outcomes and decreasing hospitalizations. OBSERVATIONS: From November 1, 2009, through August 30, 2010, the clinical pharmacist conducted visits and intervened in the care of 111 chronic heart failure patients. A pre/post analysis of those 111 patients during the 10 months before and after the integration of the clinical pharmacist showed that those patients were hospitalized 63 times in the 10 months before having regularly scheduled visits with the clinical pharmacist and 30 times in the 10 months after establishing care. This reduction from 63 to 30 visits translated to an approximate 50% decrease in heart failure hospitalizations in patients being followed by the clinical pharmacist within the first 10 months. Once the clinical pharmacist became better integrated into the workflow through development of rapport with the medical team, the outcomes improved further. In an 18-month analysis from May 1, 2010, through November 30, 2011, only 2% of patients (3 of 153) designated as high-risk patients managed by the clinical pharmacist had a 30-day readmission for heart failure exacerbation. IMPLICATIONS: Outcomes-based models have expanded opportunities for clinical pharmacist involvement and can provide unique reimbursement options. Demonstration of cost savings and an improvement in quality measures are paramount to establishing and justifying the clinical pharmacist’s role in a team-based model of care. Academy of Managed Care Pharmacy 2018-08 /pmc/articles/PMC10397892/ /pubmed/30058987 http://dx.doi.org/10.18553/jmcp.2018.24.8.795 Text en Copyright © 2018, 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 Best Practices
Schumacher, Christie
Moaddab, Golbarg
Colbert, Monique
Kliethermes, Mary Ann
The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title_full The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title_fullStr The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title_full_unstemmed The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title_short The Effect of Clinical Pharmacists on Readmission Rates of Heart Failure Patients in the Accountable Care Environment
title_sort effect of clinical pharmacists on readmission rates of heart failure patients in the accountable care environment
topic Best Practices
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10397892/
https://www.ncbi.nlm.nih.gov/pubmed/30058987
http://dx.doi.org/10.18553/jmcp.2018.24.8.795
work_keys_str_mv AT schumacherchristie theeffectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT moaddabgolbarg theeffectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT colbertmonique theeffectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT kliethermesmaryann theeffectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT schumacherchristie effectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT moaddabgolbarg effectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT colbertmonique effectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment
AT kliethermesmaryann effectofclinicalpharmacistsonreadmissionratesofheartfailurepatientsintheaccountablecareenvironment