Accountable Care Organizations (ACOs) may want to look a little deeper as to why many of their hospital patients who recently discharged are coming back within 30-days. An article in Annals of Internal Medicine, The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital, Alan Forster, MD, et al, 2003;138:161-167, stated that 66% of the measured adverse events after discharge were adverse drug events. This point is also emphasized in a presentation by Dr. Steve Hines, PhD, and found on the AHRQ website (www.ahrq.gov/news/kt/red/readmissionslides/readmission.ppt). Dr. Hines also states possible causes of these adverse events that lead to harm and readmission, those being: poor transfer of information to the patient; poor transfer of information to the ambulatory caregivers, whether they be nursing homes, caregivers, or primary care physicians; and lack of a timely follow-up visit with the primary care physician, among others.
Looking deeper at the possible causes, Dr. Hines ascribes lack of medication reconciliation as one cause, where medications are not reconciled in detail which leads to duplicate drug therapies and drug interactions, thought to cause adverse drug events in about 26% of all ADE cases. He also states that patients may not ascribe adverse effects to medications and will not ask for changes in drug therapy. Yet a well-educated patient is more likely to recognize symptoms as an adverse event, implying that patient education upon discharge is critical. One possible solution is to create a comprehensive medication plan that travels with the patient after discharge so critical lab monitoring occurs, along with key educational points on how to properly take medication, in addition to a list of key symptoms that can be likened to the medication therapies the person is taking. Lastly, designing a drug regimen that the patient can adhere to is also important, especially for people discharged after an episode for congestive heart failure. Poor adherence is strongly associated with readmission to the hospital in those with congestive heart failure.
In summary, medications play a key role in mitigating risk and improving survival and function, but when not well managed they can lead to adverse drug events that cause harm and lead to readmission to the hospital. Some data suggest that the adverse events will show up about 14 to 21 days after hospital discharge implying that a well-designed medication plan can prevent a large number of readmissions.
Here are some other links that refer to adverse drug events after discharge from hospitals.