Posts Tagged ‘medication reconciliation’

Infographic: The Impact of Medication Reconciliation on Readmission Rates

July 18th, 2016 by Melanie Matthews

Medication reconciliation programs, in which pharmacists review patients’ medication regimens and provide adherence counseling during the patient’s transition from hospital to home, reduced ths risk of hospital readmission by 50 percent and helped avoid unnecessary healthcare costs, according to a new study from the CVS Health Research Institute.

A new infographic by CVS highlights the survey findings, including details on the impact of medication non-adherence on readmission rates and how a pharmacist intervention reduced readmission risks.

Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk PatientsA clinical pharmacist-driven medication management effort at Novant Health identifies patients at high-risk for readmissions or ED visits related to adverse drug events. Using a combination of medication reconciliation, pharmacotherapy review, and patient education, Novant Health’s clinical pharmacists are working to reduce preventable readmissions by optimizing medication regimens and removing barriers to adherence among these high-risk patients.

During Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients a 45-minute webinar on February 3rd, now available for replay, Rebecca Bean, director, population health pharmacy, Novant Health, shares her organization’s medication management approach and why a clinical pharmacist is key to the program’s success.

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Infographic: Medication Management

December 28th, 2015 by Melanie Matthews

Serious medication errors occur in 3.8 million inpatient admissions each year, according to a new infographic by Sentri7.

The infographic reviews how medication errors and adverse drug events affect patients and hospitals.

A clinical pharmacist-driven medication management effort at Novant Health identifies patients at high-risk for readmissions or ED visits related to adverse drug events. Using a combination of medication reconciliation, pharmacotherapy review, and patient education, Novant Health’s clinical pharmacists are working to reduce preventable readmissions by optimizing medication regimens and removing barriers to adherence among these high-risk patients.

During Medication Management: Using Clinical Pharmacists To Complete Comprehensive Drug Therapy Management Post Discharge in High-Risk Patients, a 45-minute webinar on February 3rd at 1:30 p.m. Eastern, Rebecca Bean, director, population health pharmacy, Novant Health, will share her organization’s medication management approach and why a clinical pharmacist is key to the program’s success.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

One-Fourth Operate Post-Discharge Clinics to Curb Hospital, Post-Acute Readmissions

June 4th, 2015 by Patricia Donovan

Dedicated post-discharge clinics address medication concerns so high-risk patients don't end up back in the hospital.


Almost one-quarter of healthcare organizations—24 percent—operate dedicated post-discharge clinics for patients recently discharged from the hospital, nursing home or ED, according to the April 2015 Care Transitions Management survey by the Healthcare Intelligence Network.

A post-discharge clinic is designed to address issues related to a patient’s recent hospitalization and ensure that the individual’s transition from hospital or post-acute facility to their primary care doctor is smooth.

In a 2014 presentation, Torrance Memorial Health System described the typical operation of its follow-up clinic, the Coordinated Care Center, which is focused on medication management, a key driver of avoidable hospital readmissions. The health system stressed that the clinic is not a replacement for follow-up primary care following a hospitalization:

“One tactic [for reducing readmissions] is to encourage each of our patients going home from the hospital and SNF to make an appointment at our post-acute clinic with the physician who does medication reconciliation. She asks the patients to bring in all the medications they were on before they went to the hospital and all those prescribed at the hospital.

“They then have a 45-minute conversation, discussing medication plans moving forward, which ones they should take and which they shouldn’t, making sure with teach-back methodology the patient has a clear understanding of expectations in terms of consuming medication once they return home later that day. Those appointments normally take place within the last 72 hours.”

A dedicated post-discharge clinic is one way to plug glaring gaps in care transition management: insufficient follow-up. More work is needed during the actual patient handoff to break down the top barrier to smooth care transitions identified by HIN’s fourth annual care transitions management assessment: communications between care sites.

Source: 2015 Healthcare Benchmarks: Care Transitions Management

Care Transition Management

2015 Healthcare Benchmarks: Care Transitions Management HIN’s fourth annual analysis of these cross-continuum initiatives examines programs, models, protocols and results associated with movement of patients from one care site to another, including the impact of care transitions management on quality metrics and the delivery of value-based care.

3 Goals of Hospital Home Visits: Reconciliation, Red Flags and Re-Education

April 14th, 2015 by Cheryl Miller

Hospital-initiated home visits conducted during post-discharge follow-up significantly curb avoidable admissions, readmissions and ER visits, according to findings from the Healthcare Intelligence Network’s 2013 Home Visits e-survey.

The hospital sector is almost twice as likely to conduct home visits than other sectors, and to focus on three key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

Hospitals are much more likely to conduct home visits to conduct post-discharge follow-up than overall respondents, our survey found. Almost two-thirds of hospitals, which comprised 27 percent of the survey 155 respondents, visit patients at home following discharge, versus 43 percent overall. Hospital-initiated home visits are also half as likely to include a home assessment as visits by the overall surveyed population (16 percent of hospitals versus 37 percent of respondents overall).

A case manager most often conducts the home visit on behalf of the hospital; this sector is only one-fourth as likely to send a nurse practitioner on this visit (5 percent of hospitals versus 16 percent overall). The visits focus on key aspects of the discharge care plan: medication reconciliation, red flag recognition and patient/caregiver education.

That said, hospital case managers are more likely than their industry counterparts to offer palliative care during the visit (35 percent versus 29 percent overall), but only about half as likely to discuss nutritional status (29 percent versus 52 percent overall) or assess activities of daily living or ADL (24 percent versus 40 percent overall).

Chart reviews and EHRs comprise responding hospitals’ primary method of identifying patients in need of home visits. This sector is twice as likely to conduct home visits for 10 percent or less of its patient population (65 percent versus 37 percent overall).

Despite the frequency with which it conducts home visits, hospitals are twice as likely to report no return on investment from home visit programs (17 percent versus 9 percent overall), and are twice as challenged by home visit funding/reimbursement (61 percent versus 36 percent overall) and technology limitations (11 percent versus 6 percent overall).

Source: 2013 Healthcare Benchmarks: Home Visits

Home Visits

2013 Healthcare Benchmarks: Home Visits examines the latest trends in home visits for medical purposes, from the populations visited to top health tasks performed in the home to results and ROI from home interventions. This 40-page report analyzes the responses of 155 healthcare organizations to HIN’s inaugural industry survey on home visits.

6 Strategies Help Stem Hospital Readmissions, Streamline Processes and Care Transitions

February 27th, 2014 by Cheryl Miller

Development of post-acute partnerships with home health, skilled nursing facilities (SNFs) and hospice is emerging as a key strategy to stem hospital readmissions, according to new market data from the fourth annual Healthcare Intelligence Network (HIN) Reducing Hospital Readmissions Survey.

More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, respondents say.

Looking at more conventional approaches, medication reconciliation and telephonic monitoring of patients post-discharge emerged as frontrunner strategies to curb readmissions. Moreover, the 2013 survey revealed significant upticks in the use of each tactic over 2012 levels: medication reconciliation is now conducted by 73 percent of respondents, versus 54 percent in 2012, while the use of telephonic monitoring jumped from 48 to 71 percent over the same 12-month period.

In other new data, almost half of respondents — 47 percent — aim programs at individuals already assessed at high risk for readmission as well as traditional Medicare (53 percent), Medicaid (28 percent) and high utilizer (23 percent).

Other key findings include the following:

  • Two-thirds of respondents to HIN’s December 2013 Readmissions e-survey have a program to reduce readmissions.
  • In a new metric from the 2013 survey, more than half — 52 percent — aim readmission reduction efforts at individuals with diabetes.
  • Case management is the most successful approach to curbing rehospitalizations, say 27 percent. The case manager retains chief responsibility for reducing readmissions, say 34 percent of respondents.
  • Heart failure remains the top condition targeted by programs, although a fifth already track readmissions for hip and knee replacements, a metric the Centers for Medicare and Medicaid Services (CMS) will examine more closely in 2015.

Excerpted from 2014 Healthcare Benchmarks: Reducing Hospital Readmissions.

3 Nurse Navigator Tools to Enhance Care Management

January 29th, 2014 by Jessica Fornarotto

Where does the nurse navigator spend their day? Certainly on transitions of care. Bon Secours Health System nurse navigators use a trio of tools to identify patients’ obstacles to care and connect them to needed resources, explains Robert Fortini, vice president and chief clinical officer of Bon Secours Health System.

One tool that our nurse navigators use that’s built into our EMR is the hospital discharge registry from Laburnum Medical Center, one of our largest family practice sites with about nine physicians. This tool is used to identify which patients the navigators need to work with, and it’s where the navigators begin and end their day. This registry provides a list of all the patients who have been discharged from one of our hospitals in the last 24 hours, and each patient is listed by the physician. The navigators have to reach out to each of these patients and make telephonic touch within 24 to 48 hours of discharge. Medication reconciliation is extremely important at this time and can be very challenging. When a patient goes into a hospital, often their medications get scrambled, and they come out confused and taking the wrong prescriptions. Nurse navigators spend a lot of time on medication reconciliation at this point.

The Navigators also conduct ‘red flag’ rehearsals with this tool, so that the patient knows the signs and symptoms of a worsening condition and what to do for it. We also schedule the patient with a follow-up appointment, either with a specialist who managed the individual in the hospital or with their primary care physician. We try to do it as close to the time of discharge as possible, within five to seven days, or more frequently if the risk of readmission is higher.

Second, nurse navigators also use a documentation tool to help manage the care of heart failure patients. This tool allows the navigator to stage the degree of heart failure using a hyperlink called the ‘Yale tool.’ The Yale tool allows us to establish what stage of heart failure the patient is in: class one, two, three, or four. Then, a set of algorithms is launched based on these stages’ failure; we manage the patient according to those algorithms. For example, if a patient falls into a class four category, we might bring them in that same day, or the next day, for an appointment rather than wait five or seven days because they’re at more risk. We might also make daily phone calls or network in-home health, as well as make sure that the patient has scales for weight management and an assessment of heart failure status. All of those interventions will be driven by the patient’s class of heart failure.

The last tool we use is a workflow for ejection fractions. The patient’s ejection fraction will define specific interventions that the navigator will follow.

Excerpted from: Profiting from Population Health Management: Applying Analytics in Accountable Care.

QIO Advice for Improving Care Transitions: Dig Deep Into Local Data

June 6th, 2013 by Cheryl Miller

There is no cookbook or recipe for improving care transitions.

Instead, the first step for any healthcare organization and community-based healthcare provider is to conduct a root cause analysis of readmission data, which can vary from community to community, says Alicia Goroski, MPH, senior project director for care transitions for the Colorado Foundation for Medical Care (CFMC), the Medicare Quality Improvement Organization (QIO) for Colorado. Once established, the appropriate intervention can be selected, and quality improvement methods then used to monitor, assess, and improve the implementation of those interventions.

Goroski shared these lessons and more from 14 communities that participated in the CMS Care Transition Demonstration Project (CCTP), and detailed how the program is being rolled out in 400 communities and to over 12 million Medicare beneficiaries across the country during a recent HIN webinar, Patient Engagement and Provider Collaborations Across the Healthcare Continuum to Improve Care Transitions. CFMC coordinates the work of state-based QIOs, which are contracted by the CMS and designed to work with hospitals and community providers to improve care transitions and reduce readmissions.

According to a study in the Journal of the American Medical Association (JAMA), hospital admissions and readmissions among Medicare beneficiaries declined nearly twice as much in communities where QIOs coordinated care transition programs that engaged the whole community. Some of the programs, focused on patients, providers or both groups not only lowered key Medicare readmission rates but also reduced participants’ overall admission stats.

The key is to dig into the data locally, she says, because there is no one size fits all intervention.

In Harlingen, Texas, it was discovered that over half of the 30-day readmissions coming back in their community were from skilled nursing facilities (SNFs). So they implemented the Interact intervention. They convened all the nursing homes and created a coalition dedicated to reducing the numbers. Within the 18-month intervention period, the 30-day readmission rate for nursing homes in that Harlingen community went from about 46 percent down to 19 percent.

On the flip side, in Goroski’s home community in Denver, nearly three fourths of readmissions were occurring among beneficiaries who had been discharged home with no home health services. Instead of implementing the Interact intervention, which wouldn’t have addressed the driver of readmissions, they hired three full-time coaches for those patients who were being discharged directly home.

The CTI was also useful for medication reconciliation, Goroski continues, pointing to the three main drivers of readmissions: patient and family engagement, a lack of standard and known processes, both within and across care settings, and health information exchange.

Medication reconciliation crosses all those areas, Goroski says, and up to half of all readmissions can be attributed to medication errors, whether the problem stems from a lack of reconciliation at discharge to a lack of follow-up calls once home. Care transition coaching is helpful, in terms of coaching the beneficiary on any medication discrepancies, advising their provider and then using the correlative technology. What differentiates the coach, usually a nurse, from a medical provider is that instead of making the follow-up phone call for the patient, the coach shows them how. This intervention, usually lasting one month, has been very successful, Goroski says.

But ultimately, it takes a village to effectively improve care transitions, Goroski says. Hospitals need to work with hospitals, nursing homes, home health agencies, hospice organizations, dialysis facilities and outpatient physicians to close care gaps.