(Management Case Study) Platinum Plan: Slashing Readmission Rates Through Ambulatory Pharmacy Visits

Purpose: The purpose of this study was to examine the impact of post-discharge clinical pharmacy visits on readmission rates through utilization of a collaborative practice agreement (CPA).

Methods: Patients diagnosed with Type I and II Diabetes Mellitus, Asthma, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), and Stroke or Transient Ischemic Attack who are established with primary care within the health institution and hospitalized within the health system were identified based on electronic medical record (EMR) discharge reports. After which, coordination with the patient's primary care physician (PCP) was established to obtain a clinical pharmacy referral order. Once obtained, the patient was contacted to schedule an appointment with an ambulatory care pharmacist within 30 days of discharge. After initial consult, follow up was determined by pharmacist's clinical judgement depending on disease state severity. During these visits, the pharmacists heavily utilized a CPA to optimize medication regimens and order any necessary labs. Patients were then tracked for twelve months to analyze readmission rates.

Results: Over a twelve month study, 3,431 patients were considered eligible for the study. Of that group, 1,034 patients were denied enrollment by the PCP, classified as PCP Decline study group. Of 3,431 patients, the ambulatory pharmacy team received 2,397 referrals for unique patients. Within that group, 1,149 patients either declined scheduling an appointment with a pharmacist or were unable to be reached after three outreach attempts by the pharmacy team, classified as the Patient Opt Out study group. Of the 2,397 referrals received, 1,248 patients completed enrollment into the program, classified as the Pharmacy group. Over 12 months, 190 patients within the PCP Decline group were readmitted within 30 days (18.38%), 208 patients within the Patient Opt Out group were readmitted within 30 days (18.10%), and only 65 patients were readmitted within 30 days in the Pharmacy group (5.21%). The PCP Decline and Patient Opt Out groups will be classified as the Control Group and the Pharmacy Group will be classified as the Experimental Group. Number Needed to Treat resulted in 8. The Relative Risk Reduction (RRR) is 71.4% with a p-value of less than 0.0001.

Conclusion: This study concluded that utilizing CPAs through ambulatory care pharmacists in the post-discharge setting significantly reduced the readmission rates compared to patients who were not enrolled. The limitations of this study were lack of PCP knowledge on the program throughout the system which led to a higher number of patients opting out of the program. A future study may be needed to look at the impact of PCP-patient referral handoff. Overall, the impact of this study has led to the expansion of the ambulatory pharmacy team at the healthcare institution to increase impact on readmission rates.