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The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery.
Jennifer Bingham1, Patrick Campbell2, Kate Schussel3
1SinfoníaRx, Tucson, AZ 85701, USA. JMBingham@sinfoniarx.com.
Pharmacy (Basel, Switzerland)
|June 29, 2019
Summary
The Discharge Companion Program (DCP), a collaborative care model, reduced 30-day hospital readmissions by involving pharmacists in medication therapy management post-discharge.
Area of Science:
- Health Sciences
- Pharmacology
- Nursing
Background:
- Hospitals aim to decrease readmission rates and associated financial penalties.
- Innovative transitions of care (TOC) programs are crucial for patient management.
- The Discharge Companion Program (DCP) is an interprofessional, collaborative TOC initiative.
Purpose of the Study:
- To evaluate the effectiveness of the Discharge Companion Program (DCP) in reducing 30-day readmissions.
- To assess the impact of pharmacist-coordinated medication therapy management (MTM) within a TOC framework.
- To analyze interventions provided by the DCP.
Main Methods:
- Retrospective study design.
- Evaluation of adult patients (≥18 years) discharged with qualifying diagnoses.
- Inclusion of telephonic medication therapy management (MTM) reviews at one and three weeks post-discharge.
- Review of hospital records and DCP documentation.
Main Results:
- A total of 456 patients were referred to the DCP.
- Of 340 participants, 13% were readmitted within 30 days, compared to 17% in usual care.
- DCP pharmacists performed 1242 clinical interventions.
Conclusions:
- The interprofessional, collaborative TOC model, including pharmacist-delivered MTM, effectively reduced 30-day hospital readmissions.
- The DCP demonstrates the value of multiple pharmacist intervention touchpoints post-discharge.
- This model supports improved patient outcomes and hospital financial health.
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