title: Increasing Medication Possession at Discharge for Patients With Asthma: The Meds-in-Hand Project.
abstract: OBJECTIVE
  Many patients recently discharged from an asthma admission do not fill discharge prescriptions. If unable to adhere to a discharge plan, patients with asthma are at risk for re-presentation to care. We sought to increase the proportion of patients discharged from an asthma admission in possession of their medications (meds in hand) from a baseline of 0% to >75%.
  
  
  METHODS
  A multidisciplinary improvement team performed 3 plan-do-study-act cycles over 2 years and, using a statistical process control chart, tracked the proportion of patients admitted with asthma discharged with meds in hand as the primary outcome. An exploratory, retrospective analysis of insurance data was conducted with a convenience sample of Medicaid-insured patients, comparing postdischarge utilization between patients discharged with meds in hand and usual care. Generalized estimating equations accounted for nonindependence in the data.
  
  
  RESULTS
  Changes to the discharge process culminated in the development of a discharge medication delivery service. Outpatient pharmacist delivery of discharge medications to patient rooms achieved the project aim of 75% of patients discharged with meds in hand. In a subset of patients for whom all insurance claims were available, those discharged with meds in hand had lower odds of all-cause re-presentation to the emergency department within 30 days of discharge, compared with patients discharged with usual care (odds ratio, 0.22; 95% confidence interval, 0.05-0.99).
  
  
  CONCLUSIONS
  Our initiative led to several discharge process improvements, including the creation of a medication delivery service that increased the proportion of patients discharged in possession of their medications and may have decreased unplanned visits after discharge.
authors.affiliation: Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; and jonathan.hatoun@childrens.harvard.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hatoun
authors.affiliation: Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; and.
authors.forename: Megan
authors.initials: M
authors.lastname: Bair-Merritt
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; and.
authors.forename: James
authors.initials: J
authors.lastname: Moses
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001900:Boston; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid; D055118:Medication Adherence; D010351:Patient Discharge / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D055553:Prescription Drugs; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents; D055553:Prescription Drugs