Einstein Medical Center Philadelphia
5501 Old York Road
Philadelphia, PA 19141
Medication REACH Program
Challenge Addressed: Readmission rates within 30 days have been identified nationally by
Medicare as a notable area of healthcare spending. There has been an aggressive focus on
hospital readmissions within 30 days. Effective October 1, 2012 hospitals face stiff
penalties of 1% across all DRGs if readmission rates exceed acceptable thresholds. This
penalty will increase to 2% in 2013, and 3% in 2014. According to the Medicare Payment
Advisory Council, 18% of hospitalizations among Medicare patients discharged from the
hospital have a readmission within 30 days of discharge. This accounts for $17 billion
dollars in spending. Einstein Medical Center Philadelphia serves a large, vulnerable safety
net population and is at risk of declining reimbursement if key performance oriented
metrics for hospital readmission are not met. The costs associated with the current health
care delivery system are unsustainable which has led to new emerging models.
Needs Assessment: Medication related errors are common during transitions between
healthcare settings. It has been noted that 50% of all hospital related medication errors &
20% of adverse drug events are attributed to poor communication at transitions of care. (1)
It has been found that 30-70% occurrence of medication discrepancies at hospital
admission. (2) Low health literacy complicated the problem further. Medication nonadherence has been referred to as the Achilles heel of modern healthcare. (3) Studies have
shown that 20-50% of patients do not take prescription medications as directed.(4)
Medication non-adherence accounts for 10% of all hospital admissions.(5) This is estimated
to cost between $100-$300 billion dollars annually. (6)
Process Created: Our goal was to enhance the patient discharge process through multidisciplinary communication and direct pharmacist involvement in an effort to reduce
adverse medication events, and hospital readmissions. We developed a process we called
Medication REACH. The “R” is for reconciliation in which the pharmacist validates the
medication reconciliation to ensure completeness and accuracy. The “E” stands for the
education the pharmacist provides the patient about their medications. The “A” represents
the myriad of access to care issues. The “C” refers to follow-up counseling patient receive
after discharge. Finally, the “H” symbolized a healthy patient which is our ultimate goal.
Pharmacy residents partnered with the care management department to identify patients
who met the following criteria: ≥ 18 years of age, ≥ 5 medications, > 1 chronic condition,
≥48 hours of hospitalization, discharges to home, admission to telemetry/cardiac care unit.
Pharmacy residents then validated the medication reconciliation both at admission and
discharge to optimize the medication regimen. Patients were provided highly patient
centered education including a medication list and pill box. Pharmacy residents ensured
prescriptions were filled either at our discharge pharmacy or the patient’s local pharmacy.
Then pharmacy residents provided follow-up phone calls once within 72 hours of
discharge and weekly for 30 days.
Outcomes Achieved:
30 Day Readmission Rate (%)
25.0%
21.4%
20.0%
15.0%
10.0%
n= 42
10.6%
5.0%
n= 47
0.0%
Control Group
Medication REACH Group
Pharmacist Interventions
19%
25%
Optimization of Therapy
Optimization of Dose
Deletion of Therapy
23%
Initiation of Therapy
Other
25%
8%
Total number of patients = 47
Total number of interventions = 59
Expansions and Enhancements: Since beginning the Medication REACH program in 2010
we have opened up a discharge pharmacy to service all discharge patients. We have also
attained a full time Transition of Care Pharmacist. To allow the pharmacist to reach as
many patients as possible we developed an advanced pharmacy technician role. We have
also partnered with other organizations and healthcare professionals.
References
1. Burns, A; James, A., et al. “Improving Care Transitions: Optimizing Medication
Reconciliation” American Society of Health-System Pharmacists, March 2012: pp115.
2. Jack B. et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med. 2009;150:178-187.
3. Vermeire E, Hearnshaw H, Van Royen P et al. Patient adherence to treatment: three
decades of research. A comprehensive review. Journal of Clinical Pharmacy and
Therapeutics 2002;26:331-342.
4. Kripalani, S., et al. Development of an illustrated medication schedule as a lowliteracy patient education tool. Patient Education and Counseling. 2007, 368-377.
5. (2) The Merck Manuals: Online Medical Library. “Improving compliance.” 2003.
6. (3) Walker, T. Understanding patients needs is key to medication compliance.
Managed Healthcare Executive. 2001, 11(1), 34.