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The American Journal of Accountable Care June 2018
Amazing Grace: A Free Clinic's Transformation to the Patient-Centered Medical Home Model
Jason Alexander, BS, PCMH CCE; Jordon Schagrin, MHCI, PCMH CCE; Scott Langdon, BA; Meghan Hufstader Gabriel, PhD; Kendall Cortelyou-Ward, PhD; Kourtney Nieves, PhD; Lauren Thawley, MSHSA; and Vincent Pereira, MHA, PCMH CCE
Lessons Learned in Implementing Behavioral Screening and Intervention
Richard L. Brown, MD, MPH
The Intersection of Health and Social Services: How to Leverage Community Partnerships to Deliver Whole-Person Care
Taylor Justice, MBA, President of Unite Us
Case Study: Encouraging Patients to Schedule Annual Physicals
Nicholas Ma
Effects of an Integrated Medication Therapy Management Program in a Pioneer ACO
William R. Doucette, PhD; Yiran Zhang, PhD, BSPharm; Jane F. Pendergast, PhD; and John Witt, BS
Are Medical Offices Ready for Value-Based Reimbursement? Staff Perceptions of a Workplace Climate for Value and Efficiency
Rodney K. McCurdy, PhD, and William E. Encinosa, PhD
Utilizing Community Resources, New Payment Models, Technology to Deliver Accountable Care
Laura Joszt, MA
Currently Reading
Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related Admissions
Brennan Spiegel, MD, MSHS; Rita Shane, PharmD; Katherine Palmer, PharmD; and Duong Donna Luong, PharmD

Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related Admissions

Brennan Spiegel, MD, MSHS; Rita Shane, PharmD; Katherine Palmer, PharmD; and Duong Donna Luong, PharmD
A multivariable sensitivity analysis conducted on a pharmacy follow-up program of high-risk patients demonstrated cost savings to hospitals in 98.3% of head-to-head trials across 1000 hypothetical hospitals.
ABSTRACT

Objectives: To measure the cost-effectiveness and direct budget impact of a pharmacist follow-up program in high-risk patients versus usual care.

Study Design: Cost-effectiveness analysis of a quality improvement initiative comparing a postdischarge pharmacist program versus usual care.

Methods: Pharmacists at Cedars-Sinai Medical Center, a large, community-­based, academic medical center, contacted patients within 72 hours of discharge. Patient and prescriber drug-related problems (DRPs) were identified and resolved. Eligible patients met 1 or more of the following criteria: (1) receiving more than 10 medications, (2) having a diagnosis of pneumonia or congestive heart failure, and (3) receiving anticoagulants. The study measured annualized incremental direct hospital cost per 30-day readmission prevented.

Results: Of 185 patients identified, 90% were contacted within 72 hours of discharge; of this group, 86.4% had 1 or more DRPs. The 30-day intention-to-treat readmission rates for the program versus usual care were 16.2% and 21.6%, respectively, and the average costs per patient were $3433 and $4015, respectively (difference, $582; Monte Carlo 95% CI, $528-$635). In multivariable sensitivity analysis across 1000 hypothetical hospitals of varying size and staffing, the intervention remained cost-saving in 98.3% of head-to-head trials.

Conclusions: The previously documented efficacy of pharmacist postdischarge care remains effective in a real-world application. The program is cost-saving to hospitals operating in a population health model or capitated model.

The American Journal of Accountable Care. 2018;6(2):e1-e8

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