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A4966 - Characteristics of Patients with Airway Disease Who Opt-In to the Bedside Medication Delivery Program and Impact on Hospital Admissions and Emergency Department Visits
Author Block: L. Rogers1, P. Agarwal2, R. Yu3, D. L. Reich4, M. Mazumdar2; 1Medicine, Division of Pulmonary, CCM and Sleep Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, United States, 2Institute for Health Care Delivery Science, Icahn School of Medicine At Mount Sinai, New York, NY, United States, 3Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, United States, 4Mount Sinai Hospital, New York, NY, United States.
INTRODUCTION/RATIONALE: Adherence rates to pharmacotherapy for airway diseases are low, contributing to costly acute care visits and hospitalizations. Mount Sinai Health System (MSHS) formed a partnership with CVS Health to facilitate bedside medication delivery (BMD) prior to hospital discharge. We assessed predictors of program participation and hypothesized that pre-discharge BMD of inhaled maintenance medication would be associated with reduced likelihood of 30-day hospital readmission and emergency department (ED) visits. METHODS: We retrospectively collected demographic, socio-economic and clinical data from electronic health records (EHRs) for two cohorts between 16th February 2016 to 30th May 2017: Cohort 1) adult patients admitted with a primary diagnosis of airway diseases (N=311); and Cohort 2) those with either a primary or secondary diagnosis of airway diseases (N=5,933). Patients offered the BMD program were included in the analysis; those for whom opt-in/-out of the program could not be assessed were excluded. Follow-up data on patient enrollment and pharmacist medication counseling were collected from CVS pharmacy and MSHS EHR. Multivariable modeling examined predictors of enrollment and impact on 30-day readmissions and ED visits. The study was exempt from informed consent as a retrospective de-identified quality investigation. RESULTS: Among enrolled patients (N=3,412), 27.5% were reached by follow-up call. Cohort 1 and Cohort 2 had 22.5% and 21.5% opt-in rates. Significant subgroup differences were observed in age, Charlson Comorbidity Index (CCI), and primary diagnosis of asthma versus COPD for group 1 patients. Patients who opted out of the program were older (mean age: 62 vs. 52, p= 0.0005), trended towards higher CCI (mean CCI: 3.8 vs. 2.9, p= 0.0767) and trended towards COPD as compared to asthma (81.4% vs. 70.94%, p= 0.0629). Among Group 2 patients, those who opted out of the program showed similar subgroup differences and trends in age and CCI index. In both cohorts, those who opted were more likely to be female (OR=1.36, 95% CI 1.19 1.56), smokers (OR=1.40, 95% CI 1.16 1.68), and self-identifying as African American (OR=1.18, 95% CI 0.99 1.42). No associations were observed between opting into the program and 30-day readmissions and ED visits for either cohort. CONCLUSIONS: We were unable to identify an impact of BMD program on 30-day hospital readmission and ED visits for airway diseases and detected a relatively low utilization of the program. Strategies to improve enrollment of high-risk populations and overall engagement, and ongoing systematic evaluation of such programs are needed to properly test our hypothesis.