Cost-Effective Programs to Improve Care

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Hospital readmission is a phenomenon about which we are increasingly concerned. Rapid and frequent readmission to the hospital suggests that the initial care received might not have been optimal and/or that care transitioning was not effective. The result is tremendous stress and untoward outcomes for the patient and his/her family along with expenditures of resources for the hospital in an era following the Affordable Care Act and other measures jeopardizing the hospital’s reimbursement for patient readmissions.

Rofu et al explored the use of a risk stratification tool for a Hospital Outreach Medication Review (HOMR) program.1 They noted that past interventions even among patients with lower risk successfully reduced readmissions by 400%. The tool they piloted included several potential risk factors such as: lives alone and manages own medications, cognitive impairment, history of non-adherence, high-risk drugs, language/cultural barriers, renal impairment, and other. The tool ended up being more highly predictive than commonly used measures of morbidity, such as the Charlson comorbidity index. Those targeted through the use of HOMR received a pharmacist-led phone interview to provide support and answer questions for these patients. Those targeted incurred statistically lower likelihood of being readmitted at 30 days, 60 days, or 90 days back into the hospital. The program also generated cost-effectiveness and significant savings over a previous program that involved more intensive home medicines reviews.

Pharmacists can be effective in leading interdisciplinary efforts to improve care and reduce costs in the health care system, especially for but not exclusively related to medication therapy needs of patients. This requires continuous surveillance of internal and external environments for potential improvements in operations management, knowledge of cost-benefit evaluation, and innovativeness.

Additional information about Operations Management and Entrepreneurship and Innovation can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.

1Rafu A, Boulos D, Hanna M, et al. Validation of a risk stratification tool for a Hospital Outreach Medication Review program. Res Social Adm Pharm. 2018;

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California


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Shane Desselle about 1 year ago

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