Assessing the Impact of an Advanced Clinical Decision Support System on Medication Safety and Hospital Readmissions in an Innovative Transitional Care Model: A Pilot Study

Abstract

Background: Adverse drug events and inappropriate use of medications lead to hospitalizations, medication-related morbidity, and mortality. This study examined whether a novel medication risk prediction tool, the MedWise Risk ScoreTM, was associated with medication safety-related problem (MRP) identification and whether integrating into an existing innovative transitions of care (TOC) program could decrease readmissions. (2) Methods: This retrospective comparator group study assessed patients discharged from a hospital in southern Arizona between January and December 2020. Participants were included in the study if they were 18 years of age or 19 older, referred to the pharmacist for TOC services, and received a pharmacist consultation within one-week post discharge. Patients were categorized into two groups: 1) medication safety review (MSR)-TOC service (intervention), or 2) existing innovative TOC program (control). (3) Results: Of 164 participants, most were male (57%) and were between 70 - 79 years of age. Overall, there were significantly more DDI MRPs identified per patient in the intervention vs control group for those who were readmitted (3.7±1.5 vs 0.9±0.6, p<0.001) and those who were not readmitted (2±1.3 vs 1.3±1.2, p=0.0120). Furthermore, of those who were readmitted, the average number of identified MRPs per patient was greater in the intervention group compared to the control (6.3 vs 2.5 respectively, p>0.05). Relative to control, readmission frequency was 30% lower in the treatment group; however, there was insufficient power to detect significant differences between groups. (4) Conclusion: Integration of a medication risk prediction tool into this existing TOC model identified more DDI MRPs compared to the previous innovative TOC program, which lends evidence to support its ability to prevent readmissions. Future work is warranted to demonstrate the longitudinal impact of this intervention in a larger sample size.