Vanderbilt University Medical Center and Brigham and Women’s Hospital in Boston recently collaborated on a study analysis to determine the effect of a tailored, pharmacist-delivered health literacy intervention on unplanned hospital readmission or emergency department visit following discharge.
Reduction in 30-day readmission rates following hospitalization is a goal at Vanderbilt and hospitals across the country. Each is motivated to keep their readmission rates in check or face receiving less money from Medicare.
In this analysis, published in the Journal of General Internal Medicine, Susan Bell, MBBS, MSCI, and colleagues examined a four-pronged intervention and its impact on time to first unplanned health care event for patients with acute coronary syndrome (ACS) or acute decompensated heart failure(ADHF).
The intervention included pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids and individualized telephone follow-up after discharge.
“There are few studies that have shown intervention to be effective to reduce readmission,” said Bell, first author on the study and assistant professor of Medicine in the Division of Cardiovascular Medicine.
The researchers knew from other studies that readmissions for ACS and ADHF occur in the first two weeks but continue throughout the month.
“What we really wanted to understand was not only whether our study was going to prevent health care utilization after discharge, but at what point during the 30-day timeframe do readmissions occur. The analysis gives us two pieces of information.”
A total of 851 participants enrolled in the randomized controlled trial at Vanderbilt University Hospital and Brigham and Women’s Hospital. Overall, the results showed no significant effect on time to first unplanned hospital readmission or ED visit among patients who received the interventions compared to the control group. At Vanderbilt, there was a trend toward a reduction in unplanned health care utilization by 23 percent in the intervention group.
“It did surprise us there was no effect overall and that the intervention effect differed by site,” Bell said “In addition, the intervention was also effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.”
Health care utilization after discharge was a secondary outcome of a study that was previously published in the Annals of Internal Medicine. Sunil Kripalani, M.D., M.Sc., associate professor of Medicine, was the principal investigator and senior author.
