Hyperpolypharmacy and readmission risk among Medicare beneficiaries: the role of postdischarge care

Medication reconciliation post discharge may reduce readmission risk in populations with multimorbidity and polypharmacy. We aimed to evaluate the association between hyperpolypharmacy and 30-day readmissions; determine the impact of postdischarge care on 30-day readmissions; and identify interactions among hyperpolypharmacy, postdischarge care, and 30-day readmissions in 2 Medicare populations: individuals 65 years and older and individuals of any age with a qualifying disability.

Retrospective observational study using the 5% national sample Medicare fee-for-service claims data from 2016 to 2019.

We used descriptive statistics and generalized estimating equation models adjusted for covariates to assess the relationships among hyperpolypharmacy, 30-day readmissions, and receipt of intervention (medical care) via an evaluation and management visit or transitional care management (TCM) visit.

Hyperpolypharmacy and readmissions were higher in the disability-eligible than age-eligible group. Receiving any postdischarge care lowered the readmission risk in both groups, with particularly lower odds for those receiving TCM. Hyperpolypharmacy at admission increased readmission risk by 25% and 6% in the age-eligible and disability-eligible groups without a postdischarge visit, respectively, and by 24% and 2% when postdischarge hyperpolypharmacy was used as the primary predictor. Results were inconsistent across study groups when comparing hyperpolypharmacy effects by postdischarge visit type. Among individuals with hyperpolypharmacy, only 14.8% in the age-eligible group and 10.5% in the disability-eligible group received TCM.

Receipt of postdischarge ambulatory care was associated with lower odds of readmission; however, TCM-assisted postdischarge care may be underutilized, especially in the disability-eligible group. Cost-utility analysis studies are needed to demonstrate the value of postdischarge care, especially TCM, across different groups.