Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure
Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit. To determine the association between changes in medication regime...
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| Veröffentlicht in: | Research in social and administrative pharmacy 2016-09, Vol.12 (5), p.713-721 |
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| creator | Yam, Felix K. Lew, Tiffany Eraly, Satish A. Lin, Hsiang-Wen Hirsch, Jan D. Devor, Michelle |
| description | Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit.
To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC.
This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits.
A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911–1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001).
Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do not necessarily portend worse outcomes in patients with HF. |
| doi_str_mv | 10.1016/j.sapharm.2015.10.004 |
| format | Article |
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To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC.
This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits.
A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911–1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001).
Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do not necessarily portend worse outcomes in patients with HF.</description><identifier>ISSN: 1551-7411</identifier><identifier>EISSN: 1934-8150</identifier><identifier>DOI: 10.1016/j.sapharm.2015.10.004</identifier><identifier>PMID: 26621388</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Cohort Studies ; Emergency Service, Hospital - statistics & numerical data ; Female ; Heart failure ; Heart Failure - therapy ; Hospitalization - statistics & numerical data ; Humans ; Logistic Models ; Male ; Medication regimen complexity index ; Middle Aged ; MRCI ; Outcomes assessment ; Patient Discharge ; Patient readmission ; Patient Readmission - statistics & numerical data ; Pharmaceutical Preparations - administration & dosage ; Polypharmacy ; Retrospective Studies ; Risk ; Survival ; Time Factors ; United States ; Veterans</subject><ispartof>Research in social and administrative pharmacy, 2016-09, Vol.12 (5), p.713-721</ispartof><rights>2015</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-456d952e759cb4303cd84e9c9587176d1403c8c627e179d57b2fecda6592599f3</citedby><cites>FETCH-LOGICAL-c365t-456d952e759cb4303cd84e9c9587176d1403c8c627e179d57b2fecda6592599f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.sapharm.2015.10.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26621388$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yam, Felix K.</creatorcontrib><creatorcontrib>Lew, Tiffany</creatorcontrib><creatorcontrib>Eraly, Satish A.</creatorcontrib><creatorcontrib>Lin, Hsiang-Wen</creatorcontrib><creatorcontrib>Hirsch, Jan D.</creatorcontrib><creatorcontrib>Devor, Michelle</creatorcontrib><title>Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure</title><title>Research in social and administrative pharmacy</title><addtitle>Res Social Adm Pharm</addtitle><description>Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit.
To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC.
This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits.
A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911–1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001).
Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do not necessarily portend worse outcomes in patients with HF.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cohort Studies</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - therapy</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medication regimen complexity index</subject><subject>Middle Aged</subject><subject>MRCI</subject><subject>Outcomes assessment</subject><subject>Patient Discharge</subject><subject>Patient readmission</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Pharmaceutical Preparations - administration & dosage</subject><subject>Polypharmacy</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Survival</subject><subject>Time Factors</subject><subject>United States</subject><subject>Veterans</subject><issn>1551-7411</issn><issn>1934-8150</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1uFDEQhC0EIiHwCCAfuczEPbZnxieEVoEgReJAkqvltXt2vMwftjew75KHjZdduOZkq_RVl7qLkPfASmBQX27LaJbehLGsGMislYyJF-QcFBdFC5K9zH8poWgEwBl5E-OWMd4wEK_JWVXXFfC2PSePq95MG4zUT3RE561Jfp5owI0fcaJ2HpcB__i0p2ZyNPVIg48_aTcHqljhzJ72c1x8MkP2GDf6GA_-DF9mBEcMG5zsnjpcTEh5ZKIPPvr0N_Cu_FHSe0wYzBTpb5962mPGaGf8sAv4lrzqzBDx3em9IHdfrm5X18XN96_fVp9vCstrmQoha6dkhY1Udi0449a1ApVVsm2gqR2ILLW2rhqERjnZrKsOrTO1VJVUquMX5ONx7hLmXzuMSec9LA6DmXDeRQ0tCBCcV3VG5RG1YY4xYKeX4EcT9hqYPhSjt_pUjD4Uc5BzMdn34RSxW-c7_3f9ayIDn44A5kUfPAYdrc-ny50EtEm72T8T8QQUN6Ob</recordid><startdate>201609</startdate><enddate>201609</enddate><creator>Yam, Felix K.</creator><creator>Lew, Tiffany</creator><creator>Eraly, Satish A.</creator><creator>Lin, Hsiang-Wen</creator><creator>Hirsch, Jan D.</creator><creator>Devor, Michelle</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201609</creationdate><title>Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure</title><author>Yam, Felix K. ; Lew, Tiffany ; Eraly, Satish A. ; Lin, Hsiang-Wen ; Hirsch, Jan D. ; Devor, Michelle</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-456d952e759cb4303cd84e9c9587176d1403c8c627e179d57b2fecda6592599f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cohort Studies</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - therapy</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medication regimen complexity index</topic><topic>Middle Aged</topic><topic>MRCI</topic><topic>Outcomes assessment</topic><topic>Patient Discharge</topic><topic>Patient readmission</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Pharmaceutical Preparations - administration & dosage</topic><topic>Polypharmacy</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Survival</topic><topic>Time Factors</topic><topic>United States</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yam, Felix K.</creatorcontrib><creatorcontrib>Lew, Tiffany</creatorcontrib><creatorcontrib>Eraly, Satish A.</creatorcontrib><creatorcontrib>Lin, Hsiang-Wen</creatorcontrib><creatorcontrib>Hirsch, Jan D.</creatorcontrib><creatorcontrib>Devor, Michelle</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Research in social and administrative pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yam, Felix K.</au><au>Lew, Tiffany</au><au>Eraly, Satish A.</au><au>Lin, Hsiang-Wen</au><au>Hirsch, Jan D.</au><au>Devor, Michelle</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure</atitle><jtitle>Research in social and administrative pharmacy</jtitle><addtitle>Res Social Adm Pharm</addtitle><date>2016-09</date><risdate>2016</risdate><volume>12</volume><issue>5</issue><spage>713</spage><epage>721</epage><pages>713-721</pages><issn>1551-7411</issn><eissn>1934-8150</eissn><abstract>Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit.
To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC.
This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits.
A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911–1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001).
Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do not necessarily portend worse outcomes in patients with HF.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26621388</pmid><doi>10.1016/j.sapharm.2015.10.004</doi><tpages>9</tpages></addata></record> |
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| ispartof | Research in social and administrative pharmacy, 2016-09, Vol.12 (5), p.713-721 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aged Aged, 80 and over Cohort Studies Emergency Service, Hospital - statistics & numerical data Female Heart failure Heart Failure - therapy Hospitalization - statistics & numerical data Humans Logistic Models Male Medication regimen complexity index Middle Aged MRCI Outcomes assessment Patient Discharge Patient readmission Patient Readmission - statistics & numerical data Pharmaceutical Preparations - administration & dosage Polypharmacy Retrospective Studies Risk Survival Time Factors United States Veterans |
| title | Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure |
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