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Medication‐related readmission risk assessment in older adult patients
Author(s) -
Leffler Michaela E.,
Elliott David P.,
Thompson Stephanie,
Dean Leighton Scott
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1104
Subject(s) - medicine , hospital readmission , anticholinergic , beers criteria , emergency medicine , retrospective cohort study , medical prescription , risk assessment , cohort , intensive care medicine , polypharmacy , computer security , computer science , pharmacology
Purpose To determine if medication information can be utilized to improve the predictive value of a hospital's readmission risk assessment tool, if the number of medications prescribed increases the risk of hospital readmission, and if specific medication classes are associated with hospital readmission. Additionally, the study aimed to determine the best source of medication information for input into the pool and to assess overall effectiveness of readmission prediction. Methods A retrospective cohort study conducted at a tertiary community academic medical center. Enrollees included patients age 65 or older admitted to the hospital over a 1 year period. Exclusion criteria included absent medication reconciliation information, readmission for scheduled or elective purpose, patient previously included in the study due to a prior admission, absent readmission risk score, or if discharged to a facility for end of life care. There were 7669 admissions included, and of these, 1020 (13.3%) were followed by a hospital readmission within 30 days. Results An increased number of prescribed medications upon patient discharge, as well as the use of scheduled oral corticosteroids, opioids, anticonvulsants, and insulin were significantly associated with readmission ( P < 0.029). Medications associated with readmission when taken on a scheduled or as needed basis included oral corticosteroids, anticholinergic medications, opioids, anticonvulsants, and insulin ( P < 0.03). When medication information was incorporated into the risk assessment tool, the predictive value of the tool was improved but not enough to consider the tool to be a good predictor of 30‐day readmission. Conclusion These results suggest that certain medication classes are associated with an increased risk of hospital readmission and future efforts should be focused on improving readmission risk assessment tools or their administration.