Here - American Geriatrics Society

P OSTER
A BSTRACTS
flect the natural course of healing for these individuals. This within
group study points to a potentially better model of care for at-risk
older adults.
C116
Discharge, Drugs, and Discrepancies: The Pharmacological
Intervention in Late Life (PILL) Project.
A. M. Paquin, 1,2 T. Kostas, 1,3 M. Salow, 1,2 J. L. Rudolph. 1,3 1. Geriatric
Research Education and Clinical Center (GRECC), VA Boston
Healthcare System, Boston, MA; 2. Pharmacy Department, VA
Boston, Boston, MA; 3. Aging, Brigham and Women’s Hospital,
Boston, MA.
Supported By: Department of Veterans Affairs, Office of Geriatrics
and Extended Care (GEC) Patient-Centered Alternatives to
Institutional Care Initiative
Background: Hospital discharge, polypharmacy, and medication
discrepancies pose risks for elders, especially when they occur simultaneously.
The Pharmacological Intervention in Late Life (PILL)
Project is a quality improvement program that provides proactive
medication follow-up after a hospital stay. We aim to reduce acute
care utilization by addressing medication discrepancies and difficulties
in older patients.
Methods: This project targeted veterans >65 years old with
cognitive impairment, who were discharged home after an inpatient
admission at VA Boston. Patients received PILL pharmacist followup
after discharge which included: telephone medication review
and evaluation of regimen for pharmaceutical care issues (i.e. dosing,
drug interactions, etc.) and medication discrepancies. Medication
discrepancies were collected by comparing discharge medication
lists and actual medication orders. Patients were followed 60
days after discharge for the primary outcome of acute care utilization
(readmission, emergency department or urgent care visit) or
death.
Results: Of 285 eligible veterans, 242 patients with a mean age
of 78.9 ± 8.0 were reached by PILL pharmacist after discharge. Patients
with PILL follow-up were not significantly different than
those without (n=43) with respect to age, number of medications,
length of stay, or discrepancies. The mean number of discharge medications
was 15.1 ± 5.8, with 2.9 ± 2.3 medication changes per patient.
Among veterans receiving PILL intervention, fifty-nine percent
(59%, n=143) had at least 1 medication discrepancy, with an
average of 1.5 ± 2.1 discrepancies per patient. After adjustment for
number of medications and discrepancies, patients with PILL follow-up
had a 24% relative risk reduction in acute care utilization or
death compared to those with usual care (RR 0.76, 95% CI 0.58-
0.98).
Conclusion: Cognitively-impaired elders were discharged
home with medication lists characterized by polypharmacy, frequent
medication changes, and discrepancies. The PILL Project
demonstrated that pharmacist telephone medication review and
reconciliation results in a significant reduction in acute care utilization
or death after hospital discharge. Pharmacist post-discharge
medication follow-up shows promise as a successful model
of care.
C117
The VA Coordinated-Transitional Care (C-TraC) Program: A
Registered Nurse Telephone-Based Initiative to Improve Transitions
for Hospitalized Veterans with Dementia and Other High-Risk
Conditions.
A. J. Kind, 1,2 L. Jensen, 2 S. Barczi, 1,2 A. Bridges, 1,3 R. Kordahl, 3
M. Smith, 1 S. Asthana. 1,2 1. Univ of Wisconsin, Madison, WI; 2.
Madison VA Geriatric Research Education and Clinical Center
(GRECC), Madison, WI; 3. William S Middleton VA Hospital,
Madison, WI.
Supported By: This project was supported by a VA Transformation-
21 Grant and by a National Institute on Aging Beeson Career
Development Award (K23AG034551, National Institute on Aging,
The American Federation for Aging Research, The John A.
Hartford Foundation, The Atlantic Philanthropies and The Starr
Foundation). Additional support was provided by the University of
Wisconsin School of Medicine and Public Health’s Health
Innovation Program, and the Community-Academic Partnerships
core of the University of Wisconsin Institute for Clinical and
Translational Research (UW ICTR), grant 1UL1RR025011 from
the Clinical and Translational Science Award (CTSA) program of
the National Center for Research Resources, National Institutes of
Health.
Background: The Accountable Care Act encourages dissemination
of evidence-based transitional care programs designed to improve
patient safety and outcomes after hospital discharge, but no existing
program fully addresses the challenges of distance, dementia
and patient vulnerability common in a Veterans Affairs (VA) hospital
setting. Our objective was to test the feasibility of C-TraC — a low-resource,
nurse-led, telephone-based program which builds upon Coleman’s
transitional care model and is designed to improve care coordination
and outcomes in hospitalized veterans with dementia and
other high-risk conditions.
Methods: C-TraC launched at Madison VA Hospital in April
2010. Hospitalized veterans discharged to community settings had
to have dementia/delirium/cognitive impairment, or had to live
alone or have prior hospitalizations and be >65 years to be eligible.
Veteran characteristics, process measures and outcomes were
abstracted from the medical record for all eligible patients during
the 6 months prior to the intervention launch (N=144) and for patients
enrolled in C-TraC during its first 6 months of operation
(N=116).
Results: In the first 6 months, C-TraC successfully enrolled 116
veterans using 1.0 FTE nursing staff. No patients refused enrollment.
52% of C-TraC veterans had medication discrepancies detected/rectified
during the 48-72-hour post-discharge phone call, averaging 2 discrepancies/veteran
(range 0-9). As compared to usual care, C-TraC
veterans were more likely to leave the hospital with a scheduled follow-up
appointment (85% vs 60%, p