title: Impact of a pharmacy-based transitional care program on hospital readmissions.
abstract: OBJECTIVE
  Avoidable readmissions of patients discharged from hospitals are a major concern. This study evaluates the impact of pharmacist-provided postdischarge services on hospital readmissions for members of a US managed Medicaid health plan.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Synergy Pharmacy Solutions (SPS) initiated a transition of care (TOC) service for high-risk members of the Kern Health Systems (KHS) managed Medicaid plan. Over 1100 patients were referred to SPS between April 2013 and March 2015. KHS classified hospitalized members as high risk for readmission based on prior healthcare utilization, a health risk assessment questionnaire, and the use of the Johns Hopkins predictive modeler. This study compares SPS TOC recipients with a matched sample of KHS members discharged from nonintervention hospitals. Thirty-day and 180-day readmissions and time-to-readmission were defined as outcomes. Logistic regression and Cox model were estimated, controlling for demographics, diagnostic and drug profiles, and prior hospital utilization.
  
  
  RESULTS
  KHS identified 1763 high-risk discharges from nonintervention hospitals, of which 1005 and 669 were matched to 830 and 558 selected SPS patients in 30-day and 180-day populations, respectively. The SPS postdischarge intervention reduced the risk of readmission within 30 days by 28% (odds ratio [OR], 0.720; 95% confidence interval [CI], 0.526-0.985) and within 180 days by 31.9% (OR, 0.681; 95% CI, 0.507-0.914). The estimated effect of the SPS intervention from the Cox model was a reduction in risk of 25% (hazard ratio, 0.749; 95% CI, 0.566-0.992).
  
  
  CONCLUSIONS
  A community pharmacy-based postdischarge TOC program can significantly reduce readmission rates at 30 and 180 days compared with usual discharge care.
authors.affiliation: University of Southern California, 635 Downey Way, VPD Ste 210, Los Angeles, CA 90089-3333. E-mail: weiyini@usc.edu.
authors.forename: Weiyi
authors.initials: W
authors.lastname: Ni
authors.forename: Danielle
authors.initials: D
authors.lastname: Colayco
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Kevin
authors.initials: K
authors.lastname: Komoto
authors.forename: Chandrakala
authors.initials: C
authors.lastname: Gowda
authors.forename: Bruce
authors.initials: B
authors.lastname: Wearda
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McCombs
mesh_terms: D003157:Community Pharmacy Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D054539:Medication Therapy Management; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D000069341:Transitional Care / Q000458:organization & administration*; D014481:United States