title: Postdischarge pharmacist medication reconciliation: impact on readmission rates and financial savings.
abstract: OBJECTIVE
  To assess the impact of ambulatory clinical pharmacist medication therapy assessment and reconciliation for patients postdischarge in terms of hospital readmission rates, financial savings, and medication discrepancies.
  
  
  METHODS
  Group Health Cooperative (Group Health) in Washington State, from September 2009 through February 2010.
  
  
  METHODS
  Group Health is a nonprofit integrated group practice and health plan, operating 25 primary care medical centers and 5 specialty centers. Group Health's practice design is a patient-centered medical home model.
  
  
  METHODS
  All patients identified as high risk for readmission were followed by Group Health care management. Patients in care management who received a phone call from a pharmacist 3 to 7 days postdischarge for medication therapy assessment and reconciliation were identified as the medication review group (n = 243). Patients who did not receive clinical pharmacist intervention were included in the comparison group (n = 251).
  
  
  METHODS
  Readmission rates, financial savings, and medication discrepancies.
  
  
  RESULTS
  Patients who received medication therapy assessment and reconciliation had decreased readmission rates at 7, 14, and 30 days postdischarge, with statistical significance at 7 and 14 days. Medication review versus comparison readmission rates were as follows: 7 days: 0.8% vs. 4% ( P = 0.01); 14 days: 5% vs. 9% ( P = 0.04); and 30 days: 12% vs. 14% ( P = 0.29). Financial savings for Group Health per 100 patients who received medication reconciliation was an estimated $35,000, translating to more than $1,500,000 in savings annually. Of patients, 80% had at least one medication discrepancy upon discharge.
  
  
  CONCLUSIONS
  Most literature on medication reconciliation evaluates inpatient processes, whereas data on medication reconciliation postdischarge are limited. Our data support the hypothesis that medication assessment and reconciliation by pharmacists 3 to 7 days postdischarge can decrease readmissions and provide cost savings.
authors: Group Health Cooperative, Tukwila, WA 98168, USA. kilcup.m@ghc.org
authors: Meg
authors: M
authors: Kilcup
authors: Diane
authors: D
authors: Schultz
authors: Jim
authors: J
authors: Carlson
authors: Bruce
authors: B
authors: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration; D005260:Female; D006123:Group Practice / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors