Einstein Medical Center Philadelphia

Einstein Medical Center Philadelphia

5501 Old York Road

Philadelphia, PA 19141

Medication REACH Program

Challenge Addressed: Readmission rates within 30 days have been identified nationally by Medicare as a notable area of healthcare spending. There has been an aggressive focus on hospital readmissions within 30 days. Effective October 1, 2012 hospitals face stiff penalties of 1% across all DRGs if readmission rates exceed acceptable thresholds. This penalty will increase to 2% in 2013, and 3% in 2014. According to the Medicare Payment Advisory Council, 18% of hospitalizations among Medicare patients discharged from the hospital have a readmission within 30 days of discharge. This accounts for $17 billion dollars in spending. Einstein Medical Center Philadelphia serves a large, vulnerable safety net population and is at risk of declining reimbursement if key performance oriented metrics for hospital readmission are not met. The costs associated with the current health care delivery system are unsustainable which has led to new emerging models.

Needs Assessment: Medication related errors are common during transitions between healthcare settings. It has been noted that 50% of all hospital related medication errors & 20% of adverse drug events are attributed to poor communication at transitions of care. (1) It has been found that 30-70% occurrence of medication discrepancies at hospital admission. (2) Low health literacy complicated the problem further. Medication non-adherence has been referred to as the Achilles heel of modern healthcare. (3) Studies have shown that 20-50% of patients do not take prescription medications as directed.(4) Medication non-adherence accounts for 10% of all hospital admissions.(5) This is estimated to cost between $100-$300 billion dollars annually. (6)

Process Created: Our goal was to enhance the patient discharge process through multi-disciplinary communication and direct pharmacist involvement in an effort to reduce adverse medication events, and hospital readmissions. We developed a process we called Medication REACH. The “R” is for reconciliation in which the pharmacist validates the medication reconciliation to ensure completeness and accuracy. The “E” stands for the education the pharmacist provides the patient about their medications. The “A” represents the myriad of access to care issues. The “C” refers to follow-up counseling patient receive after discharge. Finally, the “H” symbolized a healthy patient which is our ultimate goal.

Pharmacy residents partnered with the care management department to identify patients who met the following criteria: ≥ 18 years of age, ≥ 5 medications, > 1 chronic condition, ≥48 hours of hospitalization, discharges to home, admission to telemetry/cardiac care unit. Pharmacy residents then validated the medication reconciliation both at admission and discharge to optimize the medication regimen. Patients were provided highly patient centered education including a medication list and pill box. Pharmacy residents ensured prescriptions were filled either at our discharge pharmacy or the patient’s local pharmacy. Then pharmacy residents provided follow-up phone calls once within 72 hours of discharge and weekly for 30 days.

Outcomes Achieved:

Expansions and Enhancements: Since beginning the Medication REACH program in 2010 we have opened up a discharge pharmacy to service all discharge patients. We have also attained a full time Transition of Care Pharmacist. To allow the pharmacist to reach as many patients as possible we developed an advanced pharmacy technician role. We have also partnered with other organizations and healthcare professionals.

References

1.  Burns, A; James, A., et al. “Improving Care Transitions: Optimizing Medication Reconciliation” American Society of Health-System Pharmacists, March 2012: pp1-15.

2.  Jack B. et al. A reengineered hospital discharge program to decrease re-hospitalization. Ann Intern Med. 2009;150:178-187.

3.  Vermeire E, Hearnshaw H, Van Royen P et al. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics 2002;26:331-342.

4.  Kripalani, S., et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Education and Counseling. 2007, 368-377.

5.  (2) The Merck Manuals: Online Medical Library. “Improving compliance.” 2003.

6.  (3) Walker, T. Understanding patients needs is key to medication compliance. Managed Healthcare Executive. 2001, 11(1), 34.