Evaluation of pharmacist impact on a multidisciplinary transitions of care service in Bundled Payments for Care Improvement Advanced model patients

Abstract

AbstractIntroductionRecent evidence shows pharmacist interventions on transitional care teams may reduce 30‐ and 90‐day readmissions.ObjectivesThe objective of this study was to evaluate the impact of a virtual multidisciplinary transitional care team including pharmacy services provided to Bundled Payment for Care Improvement Advanced (BPCI‐A) model patients.MethodsThis pre–post implementation retrospective cohort study included adult BPCI‐A patients with traditional Medicare and at least one of eight selected diagnosis‐related groups as the principal admitting diagnosis (sepsis, renal failure, stroke, seizure, urinary tract infection, cellulitis, chronic obstructive pulmonary disease, or pneumonia). The pre‐implementation time period was July 2021 through September 2021, and the post‐implementation time period was November 2021 through March 2022. The primary outcome was the difference between unplanned 90‐day revisits among BPCI‐A patients who received care from the multidisciplinary transitional care team (including pharmacy) versus patients receiving no care from the multidisciplinary transitional care team.ResultsOverall, patients (n = 201) were elderly (mean age ~ 73 years), evenly split male/female (51%), and Caucasian (~73%). Sepsis was the most common principal diagnosis pre‐implementation (n = 26; 28%) and stroke was the most common principal diagnosis post‐implementation (n = 33, 31%). Elixhauser comorbidity index was similar between cohorts. Pre‐implementation, 32% of patients (n = 29) had an unplanned revisit within 90 days versus 27% (n = 28) post‐implementation (p = 0.453). Pre‐implementation, 18% of patients experienced a 30‐day unplanned revisit versus 19% of patients post‐implementation (p = 0.890). The average length of stay for unplanned revisits was 7.4 days in the pre‐implementation cohort versus 8.2 days in the post‐implementation cohort (p = 0.846).ConclusionNo difference was identified in revisits pre‐ versus post‐implementation. The study may have been impacted by seasonal variation or small sample size as a 5% absolute decrease in revisits is clinically meaningful. Larger and longer studies to optimize readmission prevention strategies are needed.