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when a pharmacist fulfilled these roles. Current APPE student coverage is available weekdays from 11 am to 7 pm, with
coverage gaps for holidays and other school obligations.
While student involvement is highly dependent on the student's knowledge and experience, it is expected that they
provide the discharge counseling (with pharmacist oversight
and) with increasing independence as they progress through
the rotation. At this time, comprehensive discharge medication reconciliation is not always performed, although "Meds
2 Beds" patient medication lists are reviewed by a pharmacist as part of the dispensing process. The focus of this program is the delivery of medications with appropriate
discharge counseling and patient education.
This program was originally piloted on a medical/surgical
unit of the hospital, staffed by pharmacists at an associated
outpatient pharmacy, beginning in November 2014. The program became available to all medical/surgical floors of the
hospital, staffed by APPE students, on July 1, 2015. Although
provided by pharmacists rather than APPE students, pilot
data were included in this study for the purposes of increasing sample size. Because pharmacists fulfill the role defined
above as that of the "APPE student" when the student is
unavailable, this information was deemed appropriate for
inclusion in the study.

Study Outcomes
The primary outcome of this evaluation was 30 day all-cause,
unplanned readmission rates. Secondary outcomes included
the rate of ED visits within 30 days of discharge, overall
patient satisfaction (HCAHPS scores), and the financial
impact on the outpatient pharmacy. To determine the incidence of the readmission and ED visit, a review of the
patient's medical records up to 30 days after discharge was
performed. Patients who left the ED prior to receiving medical care were not included as an ED visit. In addition, patients
with documentation to reflect a planned admission for an
elective surgical intervention were not included as a
readmission.
For the secondary outcome of financial impact, records from
the outpatient pharmacy were reviewed. The profit was determined by patient copayment and third-party reimbursement
minus drug cost. The following endpoints were evaluated: number of prescriptions delivered per patient, profit per prescription,
total number of prescriptions delivered, and total profit.
Patient satisfaction was evaluated through comparison of
HCAHPS scores before and after the implementation of the
"Meds 2 Beds" program per unit. For the purposes of this
analysis, each unit evaluated in the study was included with
the exception of the pilot unit due to differences in timing of
program availability. Each unit's top-box score for selected
questions relevant to discharge medication and counseling
were compiled and compared. The date range for the control
group was January 1, 2015, to June 30, 2015. The date range
for the case group was July 2, 2015, to March 1, 2015. These

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date ranges were utilized to capture a similar number of participants in each group.

Study Population
Patients discharged from medical/surgical floors of the institution from May 1, 2014, to December 1, 2015, who were at
least 18 years of age were eligible for inclusion. Patients who
were not discharged to home (ie, short-term rehabilitation,
palliative care, skilled nursing facilities, long-term care facilities, etc) were excluded. Other exclusions were pregnancy,
incarceration, previously included in the study from a prior
discharge, admission to an oncology service, or a primary
cancer diagnosis (determined by ICD-9 code). Finally, any
patient who was unable to be matched to a control (on the
basis of the listed criteria listed) was excluded from the study.
Controls were initially identified on the basis of ICD-9
code and discharge from the hospital during the study time
frame. A list generated by the hospital's quality department
was utilized to identify possible controls. The medical record
of each patient included on the list was reviewed until a match
was identified. Patients were matched to eliminate potential
confounding factors that could contribute to multiple readmissions and influence results due to a limited number of participants in the "Meds 2 Beds" program. If an exact match on
the basis of ICD-9 code was unable to be identified, a last
digit-mismatched ICD-9 code patient could be used as a control if the clinical meaning of the ICD-9 code was similar (eg,
805.05 which is closed C5 fracture matched to 805.06 which
is closed C6 fracture). Patients were also matched on the basis
of primary insurance billed for admission of interest. When
possible, the best match was used (eg, Medicare matched to
Medicare), but if there was no exact match, the following
groups were identified for matching: commercial, government (Medicaid, Medicare, Tricare), other (automobile,
worker's compensation), or none. Finally, patients were
matched on the basis of 6 month admission history. If patients
had a history of hospital admission within 6 months prior to
the admission of interest, they could only be matched to a
patient who also had an admission in the last 6 months.

Statistical Analysis
This study utilized a convenience sample, as power was limited by the number of patients who participated in the "Meds
2 Beds" program during the study time frame. Demographics
of patients include age at admission (matched variable), race,
and gender. Due to inconsistent and incomplete documentation within the medical record, race was categorized as
Caucasian versus other. Additional match criteria included
number of previous admissions in the past 6 months, insurance type, and ICD-9 code. Duration of stay (days) and number of discharge medications were collected for all patients.
Number of medications delivered and duration of consultation were recorded for the "Meds 2 Beds" patients. Follow-up

Hospital Pharmacy - October 2019

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