Validation of a risk stratification tool for a Hospital Outreach Medication Review (HOMR) program

Aseel Rofu, Daniel Boulos, Mary Hanna, Bruce Jackson, John Coutsouvelis, Vivienne Mak, Noor Rofu, Tatyana Egorova, Nivethikga Uruthirasigna, Kiren Bhatia, Sue Kirsa

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1 Citation (Scopus)

Abstract

Background: Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources. 

Objective: To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review. 

Method: A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively. 

Results: 235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25). 

Conclusion: Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Original languageEnglish
Pages (from-to)1133-1137
Number of pages5
JournalResearch in Social and Administrative Pharmacy
Volume15
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • Hospital outreach medication review
  • Hospital pharmacist
  • Medication therapy management service
  • Telemedicine

Cite this

Rofu, A., Boulos, D., Hanna, M., Jackson, B., Coutsouvelis, J., Mak, V., Rofu, N., Egorova, T., Uruthirasigna, N., Bhatia, K., & Kirsa, S. (2019). Validation of a risk stratification tool for a Hospital Outreach Medication Review (HOMR) program. Research in Social and Administrative Pharmacy, 15(9), 1133-1137. https://doi.org/10.1016/j.sapharm.2018.09.018