Ochsner Health System, New Orleans, LA
Discharge Planning: Promoting Provider Awareness Regarding High-Cost Medications Commonly Prescribed Upon Discharge

Background: The CHNA provides insight into the discrepancies inherent in the care delivered to Ochsner’s patient population and identifies its most vulnerable groups. Some of the major barriers to healthcare delivery experienced by Ochsner patients include access to health services, affordability of medications, patient health literacy, and awareness of community health resources. The consideration of the elements in this report led the work group to evaluate the impact of these barriers on readmission rates. We concluded that greater resources and direction were needed in the discharge planning process. Socioeconomic status, literacy levels, community resources, and providers’ lack of knowledge of these resources contribute to poor adherence to discharge plans, particularly related to medication adherence.

Methods: Surveys were distributed to case managers, social workers, and hospital pharmacists identifying common reasons for readmission. One of the top reasons for readmission was the lack of affordability of commonly prescribed medications. A focus group with hospital pharmacists was conducted to identify barriers to obtain medications upon discharge. A common theme identified as a reason for readmission was medication cost. As a result of these focus groups, we recruited hospital pharmacists to create a reference list of commonly costly medications prescribed upon discharge. This reference list was distributed to hospital medicine teams on February 6, 2017. Readmission rates were monitored 2 months preintervention and 2 months postintervention at Ochsner Medical Center-New Orleans. Readmission was defined as any patient who was readmitted within 30 days of the original date of discharge. Readmission data were obtained from December 6, 2016 through February 6, 2017 and from February 7, 2017 through April 6, 2017.

Results: From December 6, 2016 through February 6, 2017 (preintervention), Ochsner Medical Center had 9,814 hospital admissions; of these, 547 were readmissions. From February 7, 2017 through April 6, 2017 (postintervention), the number of hospital admissions was 9,772; of these, 494 were readmissions. The total readmission rates preintervention and postintervention were 5.57% and 5.06%, respectively. The number of readmissions significantly decreased postintervention.

Conclusion: Once a specific issue was identified from the barriers of discharge planning, an intervention was implemented. One of the key components of the intervention was collaboration across hospital medicine services and all members of the care team.