Interventions to address medication-related causes of hospital readmissions: A scoping review

Abstract

Unplanned readmissions pose a tremendous burden on patients, providers, and payers.  A significant proportion of readmissions are medication-related.  Despite the availability of literature regarding hospital-level strategies to reduce readmissions, little has been written about strategies aimed at medication-related readmissions.  We sought to identify successful readmission reduction strategies by performing a scoping literature review of research published between 2000 and 2017.  We identified 21 studies that met our inclusion criteria.  From these studies, we identified 7 components frequently employed as a part of interventions to reduce medication-related readmissions: discharge planning, discharge education, post-discharge telephone calls, the use of a professional coordinator with clinical training to administer the intervention, patient education efforts, provider training efforts, and medication reconciliation.  Thirty-eight percent of all the interventions identified were associated with a statistically significant reduction in readmissions.  Of the 7 common intervention components we identified, none were consistently associated with intervention success in the full sample.  However, interventions implemented by inpatient hospitals, in particular academic medical centers, had a higher success rate than interventions implemented by other providers.   We examined a subsample of larger studies and found that discharge planning and medication reconciliation components were included in most of the successful interventions.  Future research should look beyond simply identifying components included in an intervention and should instead seek to identify contextual factors that enable or inhibit the success of these components.  Research examining discharge planning and medication reconciliation efforts will be particularly important.