title: Discharge medication complexity and 30-day heart failure readmissions.
abstract: Limited research exists regarding Medication Regimen Complexity Index (MRCI) and its utility in identifying patients at risk for hospital readmission.
  
  
  
  This study evaluates the association between discharge MRCI and 30-day rehospitalization in patients with heart failure (HF) after discharge.
  
  
  
  The study involved a retrospective, cohort study at a large tertiary teaching facility from the University HealthSystem Consortium. The consortium database was used to identify HF patients hospitalized from January 2011 to December 2013. A 30-day readmission was defined as being readmitted to the same hospital within 30 days of discharge with a principal discharge diagnosis of HF. Index hospitalizations was defined as the first hospitalization, and readmission was the subsequent hospitalization for HF. A pilot analysis was conducted to compare manual MRCI collection tool and a computerized scoring MRCI system. Multivariable logistic regression was used to examine the association of computerized MRCI (≥15) and 30-day rehospitalization after controlling for other variables.
  
  
  
  A total of 1,452 patients were included in the study with 81 patients (5.9%) readmitted within 30 days of discharge. The manual and computerized MRCIs were correlated with an R of 0.74 and R2of 0.55. The multivariate logistic regression analysis found computerized MRCI ≥15 (OR: 1.62; 95% CI: 1.01-2.59) was associated with 30-day rehospitalization after controlling for other factors. Patients prescribed angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, were less likely (OR: 0.54; CI: 0.33-0.89) to be readmitted 30 days after discharge, and patients with coronary artery disease were more likely (OR: 1.76; CI: 1.03-3.00) to be readmitted 30 days after discharge.
  
  
  
  The computerized MRCI score was moderately correlated with manual MRCI score. A significant association was found between computerized MRCI and 30-day HF readmission. Such predictive tools may allow pharmacists to prioritize patient care and optimize patient outcomes through medication therapy management.
authors: Houston Methodist Hospital, Department of Pharmacy, 6565 Fannin St., DB1-09, Houston, TX 77030, United States. Electronic address: accolavecchia@houstonmethodist.org.
authors: A Carmine
authors: AC
authors: Colavecchia
authors: Houston Methodist Hospital, Department of Pharmacy, 6565 Fannin St., DB1-09, Houston, TX 77030, United States. Electronic address: dputney@houstonmethodist.org.
authors: David R
authors: DR
authors: Putney
authors: University of Houston, Department of Pharmaceutical Health Outcomes and Policy, Texas Medical Center Campus, Room 326, 1441 Moursund Street, Houston, TX 77030, United States. Electronic address: mikejohnson@uh.edu.
authors: Michael L
authors: ML
authors: Johnson
authors: University of Houston, Department of Pharmaceutical Health Outcomes and Policy, Texas Medical Center Campus, Room 425, 1441 Moursund Street, Houston, TX 77030, United States. Electronic address: rraparasu@uh.edu.
authors: Rajender R
authors: RR
authors: Aparasu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D063886:Patient Discharge Summaries; D010359:Patient Readmission; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Acute care; Heart failure; Medication complexity; Readmission