• Christine D Jones, Amanda Anthony, Matthew D Klein, Courtney Shakowski, Holly K Smith, Amy Go, Katharine Perica, Hemali Patel, Jonathan Pell, and Read Pierce.
• J Am Pharm Assoc (2003). 2018 Sep 1; 58 (5): 554-560.

ObjectivesTo evaluate the feasibility and effect of a pharmacist-led transitions-of-care (TOC) pilot targeted to patients at high risk of readmission on process measures, hospital readmissions, and emergency department (ED) visits.SettingAcademic medical center in Colorado.Practice DescriptionPharmacists enrolled patients identified as high risk for readmission in a TOC pilot from July 2014 to July 2015. The pilot included medication reconciliation, medication counseling, case management or social work evaluation, a postdischarge telephone call, and an expedited primary care follow-up appointment.Practice InnovationImplementation and evaluation of the pharmacist-led TOC pilot program with risk score embedded into the electronic health record.EvaluationComparison of TOC-related process measures and clinical outcomes between pilot patients and randomly matched control patients included readmissions or ED visits at 30 and 90 days.ResultsWe enrolled 34 pilot patients and randomly matched them to 34 control patients. The intervention took an average of 57.1 minutes for pharmacists to deliver. More pilot patients had a case management or social work note compared with control patients (88% vs. 59%; P = 0.006 [statistically significant]). Readmission rates in pilot versus nonpilot patients, respectively, were 18% versus 24% (P = 0.547) at 30 days and 27% versus 39% (P = 0.296) at 90 days. The composite outcome of a readmission or ED visit in pilot versus nonpilot patients was 24% versus 30% (P = 0.580) at 30 days and 36% versus 49% (P = 0.319) at 90 days.ConclusionA pharmacist-led TOC pilot demonstrates potential for reducing hospital readmissions. The intervention was time intensive and led to creation of a TOC pharmacist role to implement medication-related transitional care.Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

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