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Kaiser Permanente

Impact of a Centralized Pharmacy Transitions of Care Program on 30-Day Hospital Readmission Rates for Patients Discharged from Contracted Skilled Nursing Facilities (SNFs)

Karen Cham, Pharm.D., BCPS, CPHQ Alfonso Becerra, Pharm.D., Adenola Akilo, Pharm.D., Kelvin Chan, Pharm.D., Shubhi Nagrani, Pharm.D., Jodi Loyles, Pharm.D., BCACP, Carolyn Woo, Pharm.D.

Kaiser Permanente, Northern California Region

Hospital readmission rates among patients being discharged from skilled nursing facilities (SNFs) have gained national attention. Both SNFs and hospitals receive incentive payments from the Centers for Medicare and Medicaid Services based on their performance on 30-day readmission. Medication reconciliation has been shown to reduce readmission rates. However, unlike hospital facilities, pharmacists are not routinely available on-site at SNFs to ensure the appropriateness of medication therapies. This often results in medication discrepancies. Thus, a centralized pharmacist-led transitions of care program, also known as SNF Discharge Medication Reconciliation Program, was implemented to provide medication reconciliation to patients discharged from contracted SNFs. This program aims to enhance care coordination and reduce hospital readmissions through early detection and mitigation of potential drug-related issues.

The SNF Discharge Medication Reconciliation Program leverages a centralized pharmacy model of care to provide medication reconciliation for patients within 72 hours of discharge from a SNF to a lower level of care (e.g. home, assisted living facility). This allows for an early identification of medication discrepancies, supports physicians, and improves patients’ understanding and adherence to medications. Outcome measures include hospital readmissions, Emergency Department (ED) visits pre and post coordinated medication reconciliation, total number of medication interventions, and types of interventions (i.e. adherence, omissions, inappropriate therapy, etc.).

In 2018, this program was implemented at 25 facilities across Northern California. There were 667 SNF patients included in this analysis. Patients were discharged from SNFs with an average of 15 medications total (including over-the-counter and prescription medications). The readmission rate was 8% among patients who were part of the SNF Discharge Medication Reconciliation Program compared to a readmission rate of 19% among patients who did not go through the program. An average of 3 pharmacist interventions were made during the medication reconciliation and over 90% of patients discharged had at least 1 pharmacist intervention. The most common pharmacist intervention upon medication reconciliation was gap in drug therapy (i.e. missing medication upon discharge) followed by vaccination recommendations (e.g., flu, pneumococcal, etc.). The most common gaps identified during pharmacist medication reconciliation included inaccurate prescriptions for over-the-counter agents (e.g., diabetes testing supplies), antidiabetic agents, and cardiovascular or antihypertensive agents.

There is a growing aging population with complex medical conditions who will experience multiple transitions of care over the course of their disease progression. Unresolved medication discrepancies may result in serious and preventable adverse events or increased rehospitalizations. The SNF Discharge Medication Reconciliation Program provides a collaborative and effective centralized approach enhancing medication safety and improving transitions of care across the continuum.