Characterization of geriatric drug-related hospital readmissions.
Although some factors placing geriatric patients at risk for hospitalization have been identified, little is known about drug-related problems that contribute to admissions. This study describes a protocol for characterizing drug-related problems that are associated with hospital readmissions. The protocol achieves significant improvements over other studies because geriatric readmissions to a community hospital are classified and the type of drug-related problem and relative contribution of the problem to the readmission are assessed. Thirty-five percent of study patients (n = 706) were readmitted within 6 months of their former discharge and 45 of the readmissions were drug-related. The assessments of three reviewers working independently agreed for 82% of the readmissions (kappa = 0.64). Eighteen percent of the cases identified as drug-related using the protocol were also classified as drug-related according to the hospital ICD-9 coding procedure. One percent of the readmissions classified according to the protocol as not drug-related received ICD-9 codes indicating drug-related problems. These findings suggest that the protocol identified drug-related hospital readmissions with good reliability and sensitivity. The most frequently identified drug-related problems were unexpected adverse drug reactions (n = 10), patient noncompliance (10), overdose (8), lack of a necessary drug therapy (6) and underdose (5). Drug-related factors were a major reason, rather than a contributory reason, for readmission in half of the cases. The study identifies specific drug-related problems that could become targets for preventive interventions. The majority (76%) of the problems identified were potentially preventable and the types of problems found indicate that interventions should be focused on both physicians and patients.
Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco 94109.
L A
LA
Bero
H L
HL
Lipton
J A
JA
Bird
D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D002140:California; D002985:Clinical Protocols / Q000592:standards*; D004358:Drug Therapy / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D015577:Geriatric Assessment; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D008297:Male; D015588:Observer Variation; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015203:Reproducibility of Results