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Abstract: PO1090

Physician Action on Medication Therapy Management (MTM) Recommendations Within 14 Days Associated with Lower 30-Day Readmission in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Manley, Harold J., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Aweh, Gideon N., Dialysis Clinic Inc, Nashville, Tennessee, United States
  • Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
Background

We previously reported lower 30-day readmission rates associated with MTM (vs. no intervention) in maintenance dialysis patients.* After aggressive implementation of MTM, we now compare 30-day readmission risk in a more recent cohort of Full -MTM that requires physician sign-off (including implementation orders) with Partial-MTM (med-rec with or without pharmacist review only) and determined the impact of providing Full-MTM early ≤ 14 days of discharge vs. delayed.

Methods

We reviewed electronic medical records of End-Stage Renal Disease Seamless Care Organization (ESCO) enrolled patients discharged home from acute-care hospitals between Nov 2018-Oct 2019 who returned to participating dialysis units. Patients readmitted ≤3 days, died, or entered hospice ≤30 days were excluded. Time-varying propensity score (from age, dialysis vintage, modality, cause and catheter use, prior hospitalization history, albumin, sex, marital status, and race) matched Cox models were constructed comparing hazard ratios for 30-day readmission between Full- and Partial-MTM exposure groups.

Results

MTM was provided in 1,752 discharges (456 Partial-MTM; 1296 Full-MTM). Of those, 455 Full- and 455 Partial-MTM cases were matched 1:1. Full-MTM had 25% lower risk for 30-day readmission even when compared to discharges that received partial-MTM services (HR 0.75; 95% CI 0.58-0.98). Full-MTM process was completed ≤14 days in 81% cases (n=1054). Of those, 444 early Full-MTM were matched to 444 Partial MTM cases and demonstrated a significantly lower risk for 30-day readmissions (HR 0.74, 95% CI 0.57-0.95), primarily driving the overall results.

Conclusion

Full MTM process is associated with lower 30-day readmission risk compared to Partial-MTM. The results are primarily driven by MTM process completion ≤14 days of discharge. These findings support that timely physician adjudication of pharmacists’ recommendations and subsequent actions (i.e. medication changes as needed) influence the effectiveness of MTM programs to impact readmission rates.

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

* = https://doi.org/10.1053/j.ajkd.2019.12.002