ASHP Best Practices Award Mortar and Pestle

Award Information

Implementation of a Clinical Pharmacy Specialist-Managed Telephonic Hospital Discharge Follow-Up Program in a Patient-Centered Medical Home

Sarah L. Anderson, Pharm.D., BCPS, Joel C. Marrs, Pharm.D., FNLA, BCPS (AQ Cardiology), CLS, Joseph P. Vande Griend, Pharm.D., BCPS, CGP, Rebecca L. Hanratty, M.D.


Denver Health Medical Center, Denver, Colorado

Hospital discharge can be a time of confusion for patients, especially with regard to medication use. Patients often return home with alterations to their pre-hospitalization medication regimen, including dose adjustments or discontinuation of pre-hospitalization medications and addition of new medications. As many as 1 in 5 patients experiences a post-hospital discharge adverse event and of these events approximately two-thirds are medication-related.1 The purpose of our intervention was twofold: examine the feasibility of and characteristics that define successful implementation of a clinical pharmacy specialist (CPS) telephonic hospital discharge follow-up quality improvement initiative within a patient-centered medical home (PCMH) and determine the impact of this initiative. 

Telephonic discharge follow-up was performed by two CPSs imbedded in the PCMH. The PCMH is part of a larger health system that serves a low income, minority, publicly-insured or uninsured patient population. ollow-up was performed within 48 to 96 hours of hospital discharge. The content of the phone call varied depending on the individual situation, but in general consisted of medication education, discussion of discharge information, and appointment reminders and scheduling. Each completed or attempted telephone call was documented on a barcoded telephone encounter form that was scanned into the patient’s EHR. 

Adult patients discharged between July 1, 2010 and June 30, 2011 who were enrolled in the PCMH were included in this quality improvement initiative. The CPSs attempted to contact 470 patients; of those, 207 received the telephonic intervention (contacted group) and 263 did not (not contacted group). Patients in the contacted group were more likely to attend a hospital discharge follow-up appointment (66.2% vs. 44.5%, P < 0.01) and had lower rates of 30-day readmission (22 vs. 52, P < 0.01) compared to those who were not contacted. The estimated cost to our institution of a general medicine admission is between $10,000 and $15,000 based on Medicare data; extrapolation of these admission costs to the 30 fewer readmissions that occurred in the contacted group demonstrated a cost savings potential of between $300,000 and $450,000.

Because of the positive clinical and financial impact of this type of intervention, institutions should consider allocating resources for post-hospital discharge follow-up services that include CPSs.

1. Forster AJ, Murff HJ, Peterson JF et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138:161-7.

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