Abstract 20554: Post-Discharge PharmD Medication Reconciliation and Uptitration Heart Failure Clinic Reduces 30-Day and 90-Day Readmission Rates Compared to Usual Care: An Innovative Approach to the Readmission Dilemma
Heart failure (HF) remains the most common reason for 30-day readmissions despite financial penalties enacted by CMS. Joint Commission requires medication reconciliation (MedRec) at discharge. However, discharge MedRec does not include review of medications (Rx) taken by patient (pt) at home. We set up a 7-10 day post discharge Brown Bag Clinic (BBC) (HFrEF and HFpEF=EF≤40%), where pts bring Rx from home and PharmD trained in HF Rx provides education and performs MedRec and uptitration of GDMT. Demographics, Rx, doses and labs were collected at BBC and from the EMR. We hypothesized that pts who came to BBC would have a lower 30- and 90-day readmission rate and significantly different 90-day mortality compared to a control. GDMT presented only for HFrEF pts. Data are means ± SD. Comparisons between two groups were performed using a Student’s t-test. Of 176 pts scheduled, 103 (59%) were no-shows (group “C”) vs. 73 who attended BBC (group “BBCpts”) (See Table). Age, EF, Cr were similar for BBCpts vs. C, but more women in C (54%). ProBNP was higher in C but not statistically significant. HFrEF in BBC=83%; in C=72%, in which the Rx and doses of Rxs were analyzed, p=NS. Of C, 28 (27%) were readmitted within 30 days and 19 (18%) were HF readmissions, vs. 1 (1%) readmitted as a HF readmission in BBCpts. The 90-day readmission rate in C was 54/103 (52%) [accounting for 95 all-cause readmissions, of which 57 were HF-related] vs. 8/73 (11%) in BBCpts for all-cause, p<0.0001. The 90-day mortality was 0 in BBCpts vs. 5/103 (4.9%) in C. Thus, BBC is an innovative way for MedRec and uptitration post-discharge and has shown a statistically significant difference in 30 day and 90 day readmissions as well as mortality within 90 days for BBCpts compared to pts who missed a scheduled visit. Reasons for non-attendance need to be studied further.
Author Disclosures: R. Al-Bawardy: None. S. Tandan: None. A. Cheng: None. L. Prlesi: None. J. Slyer: None. E. Borukhov: None. I.L. Piña: None.
- © 2014 by American Heart Association, Inc.