Background: Hospital-in-home (HIH) is an innovative model that provides hospital-level care in a patient's home. Pharmacists can enhance the HIH model through medication reconciliation and medication optimization.
Objectives: To integrate a clinical pharmacist into the HIH model and to conduct a formative evaluation of pharmacist contributions, including medication discrepancy resolution, cost savings, and cost avoidance.
Practice Description: This is a prospective quality improvement study conducted at the Veterans Affairs Boston Healthcare System.
Practice Innovation: We integrated a pharmacist into the HIH model. The pharmacist conducted a medication reconciliation at hospital discharge and after discharge through home video telehealth and provided longitudinal medication management.
Evaluation Methods: We adapted the PRECEDE-PROCEED model to guide program implementation. We conducted a formative evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, evaluating the reach, efficacy, adoption, and implementation of the pharmacist in the HIH team. We calculated cost savings associated with pharmacist-managed home intravenous (IV) therapy, cost avoidance from deprescribing, and cost avoidance from earlier hospital discharge.
Results: The HIH program enrolled 102 patients from May 2019 to March 2020. The pharmacist completed 99 (97%) discharge and 95 (93%) postdischarge medication reconciliations, most of which 71 (75%) were conducted using home video telehealth. The pharmacist identified and resolved a total of 453 medication discrepancies: 181 (40%) at discharge and 272 (60%) during postdischarge medication reconciliation. A total of 84 (19%) discrepancies were considered high risk. The pharmacist managed 104 days of home IV therapy, resulting in a cost savings of approximately $17,000. The cost avoided by identifying and deprescribing 145 inappropriate medications was approximately $51,000. The cost avoided by earlier hospital discharge was $1.2 million.
Conclusion: Integrating a pharmacist into the HIH model enables the detection and resolution of medication discrepancies. Cost savings from medication deprescribing, cost avoided from pharmacist-managed home IV therapy, and cost avoided from early hospital discharge totaled $1268 million.
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http://dx.doi.org/10.1016/j.japh.2021.01.003 | DOI Listing |
J Clin Med
November 2024
Department of Physiology, Faculty of Medicine, King Saud University, Riyadh 11495, Saudi Arabia.
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Galecto Biotech AB, Cobis Science Park, Ole Maaloes Vej 3, DK-2200 Copenhagen, Denmark.
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November 2024
Centre of Neurology and Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research (HIH), University of Tübingen, Hoppe- Seyler- Str. 3, 72076, Tuebingen, Germany.
Brain Commun
September 2024
Institute of Cognitive Neurology and Dementia Research (IKND), Otto von Guericke University Magdeburg, Magdeburg 39120, Germany.
Age-related differences in cortical microstructure are used to understand the neuronal mechanisms that underlie human brain ageing. The cerebral vasculature contributes to cortical ageing, but its precise interaction with cortical microstructure is poorly understood. In a cross-sectional study, we combine venous imaging with vessel distance mapping to investigate the interaction between venous distances and age-related differences in the microstructural architecture of the primary somatosensory cortex, the primary motor cortex and additional areas in the frontal cortex as non-sensorimotor control regions.
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September 2023
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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