Abstract
Objective: The purpose of this study is to evaluate the association between having chart reviews performed by a consultant pharmacist working under a collaborative practice agreement (CPA) and rehospitalization rates from SNF’s.
Design and Methods: A multi-site, prospective, case-control study assessing rehospitalization rates before and after utilizing a consultant pharmacist working with physicians under a CPA in SNF’s across the state of Utah. Six-month pre-and post-hospitalization rate data was collected directly from the individual SNF’s. A 2-sided t-test (p=0.05) comparing percentages was performed to determine whether there was a significant difference between 30-day rehospitalization rates
Results: The overall pre-and
post- 30-day hospitalization rate for all of the facilities combine were 9.93 + 5.07% and 9.16 + 6.18% (p= 0.77). Of the nine facilities included in the study, one facility had a statistically significant decrease in 30-day hospitalization rates after having a consultant pharmacist performing medication review (9.78 + 3.44% vs. 5.57 + 3.46%, p=0.032). Four of the nine facilities had a decrease in rehospitalization rate, whereas five of the facilities had an increase in rehospitalization rates.
Conclusions: The data collected from this study was unable to determine a correlation between hospital rates and having a consultant pharmacist performing medical chart reviews under a CPA at skilled nursing facilities.
Recommend0 recommendationsPublished in College of Pharmacy, Virtual Poster Session Spring 2021
Responses
Nice work!!! Mandee – I wonder if you can specific specific reasons to why two settings have the significant reduction of hospitalization rates but these were not observed in other settings.
Thank you so much Dr. Chaiyakunapruk! I have also been trying to figure out this question…it is hard to give a reason truly, just based on how many confounding factors there were. There was no way to tell if the patient populations were less ill in those two facilities, or if the census was down during the times we studied, or if there were fewer medications administered in those facilities. There are a lot of reasons that come to mind, so, unfortunately, I do not have a great answer for you as to why those two facilities did have a significant reduction!
Great poster, Mandee. I really liked the organization and the color scheme! If you were going to design a follow up study to this one, what do you think you would focus in on?
Thank you, Dr. Witt! I really would want to focus on having similar patient populations throughout the facilities we are looking at (long-term vs. short-term) or at least stratify the data based on the patient population. I would also want to include a much larger selection of facilities. I would also want to focus my objective on something like the number of interventions made rather than hospitalization rates. I
Great topic – I hope Dr Stout is involved in more pharm d projects in this area!
Thank you Dr. Gunning! I hope so as well! I feel like there is a lot of room for growth in this subject!
Mandee – Congratulations on the work you have done on this poster!! What would be some potential follow up studies?
Thank you so much! I really would love to look at number of interventions. Also, based on the comment left by Dr. Keefe and previous studies completed, I think it would be interesting to look at satisfaction of other employees in the skilled nursing facilities.
Important study. Thanks.
Thanks so much Jane!
Mandee, I’m so happy to see how this has come together for you, as I know there were moments, at least in the beginning, when that outcome wasn’t so clear! Kudos for staying with it and presenting such important work. I like your thought of additional outcomes, in addition to re-hospitalization. I also wonder if the satisfaction of other employees of the facility, such as nursing staff, should be considered, given the results of your survey. Maybe overall having the onsite pharmacist also saves a site money and contributes to overall better patient care (even if not reflected in re-hospitalization rates) because employment satisfaction of the other staff is higher?
Thank you Dr. Keefe! I was also very excited to have it all come together! We definitely had some bumps in the road with losing facilities, which really decreased our amount of data, but I think we were able to get some good ideas from this study that can be implemented into future studies. I do think that an economic outcome as well as employee satisfaction outcome would both be very interesting things to look at. I think they would really show the well-rounded benefit of having a pharmacist, rather than just the clinical benefit.
Hi Mandee!! I thought your research idea was GREAT! I wonder if more data needed to be collected over a longer time frame to show a difference? Maybe the pts that involved for this time frame were too healthy or maybe management at these facilities is very good. I really liked the poster and was able to get the key take-aways quickly. Good work!! Congrats, too, on the residency!!
Trish!! I hope you have been doing well! I miss our little group over at the VA! Thank you so much! I also feel like the time line needed to be expanded! Realistically it would be great to be able to get data from multiple states that use similar models to Jaron’s model. It would be very interesting to see the outcomes with larger amounts of data! I also think it would be very helpful to separate the facilities by short-term and long-term facilities to help have more similar patient populations!
Hi Mandee, it’s great to see how your project with Dr. Stout turned out. This is important pioneering work and although the results are not straight-forward to interpret, you have identified several important confounding variables and different metrics to use besides hospitalization rates in future studies. Based on your work, the next phase of this project is likely to yield valuable information.
Thank you Dr. Blumenthal! I am really hoping that there will be follow-up projects in the future to help move this forward. I think that a lot of rewarding things could come from additional projects in this area of research!
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