title: Economic and patient satisfaction outcomes of a layered learning model in a small community hospital.
abstract: OBJECTIVE
  Results of a study of economic and patient satisfaction outcomes of implementing a "layered learning model" (LLM) in a community hospital are presented.
  
  
  METHODS
  An LLM consisting of a clinical pharmacist, two postgraduate year 1 pharmacy residents, and pharmacy students participating in rounds and providing patient education was implemented at a small community hospital. The primary endpoint was the difference in mean total drug cost per discharge in cases managed by physicians who rounded with pharmacy representatives (the intervention group) and cases managed by physicians who rounded with no pharmacist present (the control group). Secondary outcomes were drug expenditures associated with eight common diagnoses and patient satisfaction scores in medication education domains of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Statistical analysis was performed using Student's t test and chi-square tests.
  
  
  RESULTS
  The intervention-group data comprised 2737 hospital discharges, as compared with 3983 discharges for the control group. The geometric mean total drug cost per discharge was $161.52 for the intervention group, as compared with $210.15 for the control group (difference, $48.63; p < 0.001); drug costs for pneumonia and urinary tract infection were significantly lower for the intervention group. Patient satisfaction scores were significantly improved in the intervention group relative to baseline scores (8th percentile versus 39th percentile, p < 0.001).
  
  
  CONCLUSIONS
  Implementation of the LLM in a small community hospital reduced medication costs and improved HCAHPS patient satisfaction scores.
authors.affiliation: University Hospitals Geauga Medical Center, Chardon, OH, and Northeast Ohio Medical University College of Pharmacy, Rootstown, OH. msoric@neomed.edu.
authors.forename: Mate M
authors.initials: MM
authors.lastname: Soric
authors.affiliation: University Hospitals Health System, Shaker Heights, OH.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Glowczewski
authors.affiliation: University Hospitals Geauga Medical Center, Chardon, OH.
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Lerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016527:Drug Costs; D005260:Female; D006764:Hospitals, Community / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D017060:Patient Satisfaction; D010593:Pharmaceutical Services / Q000191:economics; D010595:Pharmacists / Q000191:economics; D064172:Pharmacy Residencies / Q000191:economics / Q000379:methods*; D024382:Professional Role; D013339:Students, Pharmacy