title: Can the targeted use of a discharge pharmacist significantly decrease 30-day readmissions?
abstract: BACKGROUND
  The prevalence and cost of hospital readmissions have gained attention. The ability to identify patients at high risk for hospital readmission has implications for quality and costs of care. Medication errors have been shown to increase the risk for readmission.
  
  
  OBJECTIVE
  To study the impact of a pharmacist-based predischarge medication reconciliation and counseling program on 30-day readmission rates and determine whether polypharmacy and problem medications are important screening criteria.
  
  
  METHODS
  A prospective, nonrandomized cohort study performed at a single medical-surgical unit with telemetry capability at a single academic medical center. The participants were 729 patients, aged 18 years and older, who were discharged between July 1 and October 29, 2010. The intervention was pharmacist medication reconciliation and counseling based on a screening tool. The primary outcome was 30-day readmission rate. Secondary outcomes were the presence of polypharmacy and problem medications and their relationship with observed 30-day readmission rate, including calculation of a problem med/polypharmacy score.
  
  
  RESULTS
  The pharmacy review group (n = 537) had a lower 30-day readmission rate than the group receiving usual care (n = 192) (16.8% vs 26.0%; odds ratio [OR] 0.572; 95% CI, 0.387-0.852; P = .006). Polypharmacy, defined as either 5 or more or 10 or more scheduled medications, alone and in combination with at least one problem medication had higher 30-day readmission rates. A score of no factors present exhibited good negative predictive value.
  
  
  CONCLUSIONS
  Medication reconciliation and counseling by a pharmacist reduced the 30-day readmission rate. Polypharmacy and problem medications appear to have value individually and together. A pharmacist, guided by a screening tool in predischarge medication reconciliation, is one option to effectively reduce 30-day readmissions.
authors.affiliation: University of Kansas Medical Center, Kansas City, Kansas;
authors.forename: Aroop
authors.initials: A
authors.lastname: Pal
authors.affiliation: University of Kansas Medical Center, Kansas City, Kansas;
authors.forename: Stewart
authors.initials: S
authors.lastname: Babbott
authors.affiliation: University of Kansas Hospital, Kansas City, Kansas. Corresponding author: Aroop Pal, MD, University of Kansas Medical Center, 6048 Delp, 3901 Rainbow Blvd., Kansas City, KS 66160; phone: 913-588-6005; fax: 913-588-3877; e-mail: apal@kumc.edu.
authors.forename: Samaneh Tavalali
authors.initials: ST
authors.lastname: Wilkinson
keywords: discharge; hospital; medications; pharmacist; polypharmacy; readmission; screening