Evaluation of pharmacist impact on a multidisciplinary transitions of care service in Bundled Payments for Care Improvement Advanced model patients

Introduction: Recent evidence shows pharmacist interventions on transitional care teams may reduce 30- and 90-day readmissions. Objectives: The objective of this study was to evaluate the impact of a virtual multidisciplinary transitional care team including pharmacy services provided to Bundled Payment for Care Improvement Advanced (BPCI-A) model patients. Methods: This pre-post implementation retrospective cohort study included adult BPCI-A patients with traditional Medicare and at least one of eight selected diagnosis-related groups as the principal admitting diagnosis (sepsis, renal failure, stroke, seizure, urinary tract infection, cellulitis, chronic obstructive pulmonary disease, or pneumonia). The pre-implementation time period was July 2021 through September 2021, and the post-implementation time period was November 2021 through March 2022. The primary outcome was the difference between unplanned 90-day revisits among BPCI-A patients who received care from the multidisciplinary transitional care team (including pharmacy) versus patients receiving no care from the multidisciplinary transitional care team. Results: Overall, patients (n = 201) were elderly (mean age similar to 73 years), evenly split male/female (51%), and Caucasian (similar to 73%). Sepsis was the most common principal diagnosis pre-implementation (n = 26; 28%) and stroke was the most common principal diagnosis post-implementation (n = 33, 31%). Elixhauser comorbidity index was similar between cohorts. Pre-implementation, 32% of patients (n = 29) had an unplanned revisit within 90 days versus 27% (n = 28) post-implementation (p = 0.453). Pre-implementation, 18% of patients experienced a 30-day unplanned revisit versus 19% of patients post-implementation (p = 0.890). The average length of stay for unplanned revisits was 7.4 days in the pre-implementation cohort versus 8.2 days in the post-implementation cohort (p = 0.846). Conclusion: No difference was identified in revisits pre- versus post-implementation. The study may have been impacted by seasonal variation or small sample size as a 5% absolute decrease in revisits is clinically meaningful. Larger and longer studies to optimize readmission prevention strategies are needed.