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Need More Evidence that Patient Education Can Reduce Readmissions? Start Here.
Arti Bhavsar, Pharm.D., Consulting Manager, Truven Health Analytics
As healthcare practitioners and administrators, we are keenly aware of the complexities associated with preventing readmissions. Common questions that come to mind when tackling the readmissions dilemma include: What patient care and education interventions can we implement? Do we have a solid transition of care program? What is the cost impact to my organization, from direct costs to loss in reimbursement? Most importantly, how can we embed sustainable programs to avoid readmissions?
Take for example the impact of medication management related issues as a factor for readmissions. In an evaluation conducted by Feignbaum, et al. at Kaiser Permanente, researchers studied factors contributing to readmissions within 18 hospitals (1). Medication management issues impacted 28 percent of preventable readmissions and were identified as one of the top five areas for to prioritize for organizational intervention programs. Upon interviewing 189 patients and caregivers, researchers found that 32 percent of patients indicated they would have liked to have received more communication regarding their medications, and of these, 73 percent of caregivers indicated that lack of information was one of the components that lead to a readmission (1). This data, coupled with a recently published article by Mixon, et al. focusing on post-discharge medication errors, highlights a significant area of opportunity to prevent medication management related issues. The study indicates that medication errors ranging from omissions, commissions, and misunderstanding in indication, dose, and frequency were found in 50 percent of patients after hospital discharge (2). The groups most impacted were those with low health literacy and numeracy scores (2). These statistics are sobering and should make us want to re-evaluate our current approach towards medication-related patient education in order to improve our practices to reduce the risk for patient harm and eliminate avoidable readmissions.
When creating a strategic approach to reduce medication management related readmissions and errors, organizations should consider the following areas of improvement:
- Integrate medication handouts into Electronic Health Records (EHR) to optimize clinician work flow and enhance the patient discharge process
- Provide patient education handouts that adhere to health literacy standards to improve patient comprehension and retention of medication management related topics with tools designed for those with greatest risk of non-compliance (low health literacy and numeracy)
- Embed a “Teach-back Process” to validate patient and/or caregiver comprehension of the medication management related information provided
- Provide low-literacy aids to augment learning with tools such as pill-boxes, text messages, and/or daily medication schedules
These interventions are not only meaningful for the clinical outcome improvement results they can provide, but they are also aligned with safety, regulatory standards, and compliance standards that lead to higher reimbursement payments. These incented standards range from reduction in readmissions related to medication management events, to attestation for Meaningful Use Stage II criteria for integrated patient education and improving patient satisfaction scores as evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Pharmacists, physicians and nurses, it’s time to ask yourself how your organization is approaching medication-related patient education. Has your organization mobilized the medication-related experts who impact care decisions at the point of care? Do you have the opportunity to improve your work flow to make time for caregivers to exercise best practices in education on discharge? Do you know how many patients you are discharging with medication errors? These questions can help you on the journey to reduce your medication management related risk and improve your organizational approach.
(1) Feigenbaum P, et al. Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals. Med Care. 2012 Jul:50(7):599-605.
(2) Mixon AS, et al. Characteristics associated with post discharge medication errors. Mayo Clin Proc. 2014 Aug:89(8):1042-51.
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Integration of Patient Education and Clinical Decision Support is on the Rise in Support of Meaningful Use
There is a growing trend in the adoption of Micromedex evidence-based patient education, discharge instructions, patient engagement and Clinical Decision Support
(CDS) resources into hospital and health system EHRs. This type of integration makes resources accessible to clinicians at the point of care, and supports Meaningful Use (MU) certification of EHR vendor systems and hospital attestation for incentive payments. Thus far in 2014, over 110 hospitals have purchased integrated solutions directly from Truven Health, including Micromedex CareNotes, and CDS modules from the Micromedex Clinical Knowledge Suite. In addition, more than 200 hospitals and dozens of physician practices have chosen Micromedex content for integration from Truven Health's partnership network. Read more
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IN THE SPOTLIGHT
Truven Health Analytics Featured in CIO Review Magazine 100 Most Promising Big Data Companies
Revolutionizing the Healthcare Sector with Big Data Analytics
In the wake of a major change that the healthcare industry is witnessing in the form of the Affordable Care Act, the need for analytics and consulting services that enable organizations to efficiently manage their population has increased. With over three decades of experience, Truven Health Analytics is a leading analytics provider leveraging their extensive data assets to provide insights, improving performance and productivity of healthcare institutions and payers. This is an except from Business Wire.
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Important Notice: Micromedex Solutions Ending Support for Microsoft Windows XP and Internet Explorer 7
Beginning October 1, 2014, the Microsoft Windows XP Operating system and Microsoft Internet Explorer browser version 7 (IE7) will no longer be a supported operating system or browser for all Micromedex Solutions, which includes Micromedex 2.0, Micromedex Pharmaceutical Knowledge, CareNotes, RED BOOK and Formulary products; and all CD delivered or locally installed products, including Healthcare Series, Neofax, Pediatrics, Kinetidex, CKO/Ultimedex, and Micromedex 360 Care Insights. This means the following:
- Micromedex Solutions products will no longer be tested in Windows XP and IE7 after September 30, 2014
- Defects deemed exclusive to Windows XP and IE7 will not be addressed or fixed after September 30, 2014
You can continue to use Windows XP and IE7, understanding that Micromedex Solutions products will no longer be tested and defects deemed exclusive to Windows XP and/or IE7 will not be addressed after September 30, 2014.
If you have additional questions about this upcoming change, visit micromedex.com/support-notifications.
Creatinine Clearance Calculator Enhancements Now Available in Micromedex Medication Management
When it comes to calculating creatinine clearance, there has been much debate over which weight variable (actual body weight, ideal body weight, lean body weight, or adjusted body weight) to use in the equation (Cockcroft-Gault). As a result, the creatinine clearance calculator in Micromedex Medication Management has been enhanced to allow the user to enter a patient's actual body weight to calculate estimated creatinine clearance. Based on the best available evidence in peer-reviewed literature, an algorithm has been created, incorporating body mass index, to determine which of the weight variables to use.
Confidently calculate creatinine clearance for your patients, no matter what their age, with evidence-based resources in Micromedex Medication Management.
Parenteral Nutrition Order Enhancement for NeoFax and Pediatrics Solutions
Due to a severe shortage of electrolyte product in the U.S., clinicians can now substitute imported European Glycophos for parenteral nutrition orders. This enhancement helps streamline workflow in our Standard and Expanded NeoFax® and Pediatric solutions.
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CLINICAL CONTENT UPDATES
Selected New Drug Approvals - New Monographs and Patient Medication Instructions
U.S. Food and Drug Administration (FDA)
Antihemophilic Factor [Recombinant], Fc fusion protein (Eloctate™): Approved for the prevention, control, and perioperative management of hemophilia A in adults and children. Eloctate™ contains a protein fragment, Fc, which allows for a longer duration in the blood and fewer injections. More frequent dosing may be needed for children younger than 6 years.
Belinostat (Beleodaq®): Accelerated approval for the treatment of relapsed or refractory peripheral T-cell lymphoma (PTCL). Frequent liver function monitoring is required, as one hepatotoxicity fatality has been reported.
Efinaconazole (Jublia®): Approved for the topical treatment of onychomycosis of the toenails due to Trichophyton rubrum and Trichophyton mentagrophytes.
Idelalisib (Zydelig™): Approved for the treatment of patients with relapsed chronic lymphocytic leukemia (CLL), in combination with rituximab, in patients for whom rituximab alone would be considered appropriate therapy due to other co-morbidities; relapsed follicular B-cell non-Hodgkin lymphoma (FL) in patients who have received at least two prior systemic therapies, and relapsed small lymphocytic lymphoma (SLL) in patients who have received at least two prior systemic therapies.
Insulin inhalation powder (Afrezza®): Approved for the treatment of diabetes mellitus. Available as a single-use cartridge, it must be used in conjunction with long-acting insulin in those with type 1 diabetes. Not recommended for smokers or patients with chronic lung disease, and it carries a boxed warning for acute bronchospasms in patients with asthma and COPD.
Oxycodone hcl/naloxone hcl (Targiniq™ ER): Approved to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Targiniq ER is the second ER/LA opioid analgesic with abuse-deterrent properties consistent with the FDA’s 2013 draft guidance for industry.
Recombinant C1-esterase inhibitor (Ruconest®): The first recombinant C1-esterase inhibitor indicated for adults and adolescents with hereditary angioedema (HAE). Purified from the milk of genetically modified (transgenic) rabbits, the intravenous injection is intended to treat acute attacks of swelling by increasing functional C1-esterase inhibitor levels in plasma.
Tavaborole (Kerydin™): Approved for the treatment of onychomycosis of the toenail caused by Trichophyton rubrum or Trichophyton mentagrophytes fungi. First topical oxaborole treatment for this type of fungal infection.
Tedizolid phosphate (Sivextro™)
: Approved to treat adults diagnosed with acute bacterial skin and skin structure infections (ABSSSI) caused by Staphylococcus aureus (including MRSA), Enterococcus faecalis, and various Streptococcus species. Available for intravenous or oral use and is the second drug approved by the FDA to treat ABSSSI since May 2014.
European Medicines Agency Approvals (not already approved by the FDA) - New Monographs
Empagliflozin (Jardiance®):Indicated in the treatment of type 2 diabetes mellitus to improve glycemic control in adults.
New FDA-Approved Indications - Revised Monographs and Patient Medication Instructions
Aflibercept: Now approved for treatment of diabetic macular edema (DME). As a vascular endothelial growth factor (VEGF) inhibitor, aflibercept treats DME by blocking the growth of new blood vessels that leak fluid into the retina. Clinical studies indicate that patients treated with aflibercept experienced significant improvements in central vision, gaining the ability to read about 2 additional lines of an eye chart compared with almost no change in the control group. Serious arterial thromboembolic events have occurred with intravitreal use of VEGF inhibitors. In addition, intravitreal injection may cause serious ocular side effects, such as increased eye pressure, retinal detachment, and cataracts.
Coagulation factor VIIa [recombinant]: Now approved for IV administration in adults and children with Glanzmann thrombasthenia refractory to platelet transfusions, with or without antibodies to platelets.
Ibrutinib:Now approved for the treatment of patients with chronic lymphocytic leukemia (CLL) who carry a deletion in chromosome 17 (17p deletion), which is associated with poor responses to standard treatment for CLL. Imbruvica received a breakthrough therapy designation for this use.
Technetium 99m tilmanocept: Now approved for the detection cancer-free sentinel lymph nodes closest to a primary tumor in patients with cancer of the head or neck. This indication will reduce the extent of lymph node surgery in patients who have cancer-free lymph nodes.
Drug Safety Updates - Revised Monographs and Patient Medication Instructions
Acne OTC products: The FDA announced that it has identified 131 cases of hypersensitivity reactions to certain over-the-counter (OTC) topical acne products. It is unknown whether these reactions were caused by the active ingredients (benzoyl peroxide or salicylic acid), inactive ingredients, or both. Manufacturers are encouraged to add new directions that recommend use of a small test area of the skin for 3 days before full first-time use.
Docetaxel: The FDA warned that the chemotherapy drug docetaxel contains alcohol and may cause feelings of intoxication during or after treatment.
Lidocaine viscous: The FDA announced a new boxed warning requirement for prescription oral viscous lidocaine 2% solutions, warning against use in infants and children with teething pain. Accidental ingestion of viscous lidocaine can result in seizures, severe brain injury, and heart problems.
Testosterone products: The FDA announced it is requiring manufacturers to add a general warning to the labels of all approved testosterone products about the risk of venous blood clots. A previous warning indicated that the risk of venous blood clots was a possible consequence of polycythemia; however, post-marketing reports include cases unrelated to polycythemia.
Insulin inhalation powder (Afrezza®): The FDA is requiring a REMS study to evaluate the risk of pulmonary malignancy.
Other Significant Updates
The CareNotes Redesign Project is now complete. The full set of CareNotes care and condition documents have undergone complete revision to create actionable, direct, and streamlined patient instructions to promote patient activation supported by the most current, evidence based medical research. Editorial writing guidelines for CareNotes have been revised with an emphasis on shortening the documents, writing at a 5th to 7th grade reading level or lower, and following the latest standards in Health Literacy. A new and improved library of full-color, 3D images has also been incorporated to improve understanding of important concepts, information, and instructions included in the documents.
46 New Care Notes: New patient instructions cover topics in the areas of cardiology, dermatology, endocrinology, gastroenterology, hematology, infectious diseases, orthopedics, otolaryngology, primary care, pulmonology, radiology, sports medicine, surgery, and urology.
50 Revised Care Notes: Topics have been revised to incorporate new evidence and new and updated clinical guideline recommendations from the American College of Cardiology, American Heart Association, 8th Joint National Committee (JNC8) on High Blood Pressure, the Centers for Disease Control and Prevention and other leading guideline developers.
Selected NeoFax and Pediatrics Content Updates
New Monographs and Calculators
sodium polystyrene sulfonate
acyclovir, aminophylline, amiodarone, amphotericin B, ampicillin, anidulafungin, arginine, azithromycin, aztreonam, bumetanide, caffeine citrate, cefazolin, cefepime, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, chloramphenicol, cimetidine, clindamycin, clonidine, dexamethasone, dextrose, digoxin, digoxin immune Fab (ovine), dobutamine, dopamine, enalaprilat, epinephrine (adrenaline), epoetin alfa, erythromycin, esmolol, famotidine, fentanyl, fluconazole, flumazenil, fosphenytoin, furosemide, gentamicin, hepatitis B vaccine (recombinant), hydralazine, hydrocortisone, imipenem/cilastatin, immune globulin (human), lamivudine, levalbuterol, levetiracetam, lidocaine - antiarrhythmic, lidocaine - CNS, linezolid, lorazepam, meropenem, methadone, metronidazole, morphine, naloxone, nevirapine, nicardipine, omeprazole, oseltamivir, oxacillin, penicillin G, pentobarbital, piperacillin/tazobactam, poliovirus vaccine enhanced-inactivated, rotavirus vaccine (Rotarix®), rotavirus vaccine (RotaTeq®), sodium glycerophosphate, ticarcillin/clavulanate, tobramycin, valganciclovir, vancomycin, zidovudine
Revised Enteral Formulas
New Monographs and Calculators
factor VIII (recombinant), Fc fusion protein, lovastatin, mesalamine, mixed grass pollen allergen extract, simvastatin, sodium polystyrene sulfonate, timothy grass pollen allergen extract
acetazolamide, acyclovir, adalimumab, albumin (human), alglucosidase alfa, aminophylline, amiodarone, amlodipine, amoxicillin/clavulanate, amphotericin b, ampicillin, anidulafungin, arginine, atazanavir, atenolol, atorvastatin, azathioprine, azithromycin, aztreonam, budesonide, bumetanide, bupropion, carbamazepine, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, chloramphenicol, cimetidine, citalopram, clarithromycin, clindamycin, clonidine, cyclosporine, daptomycin, darunavir, dexamethasone, dextrose, diazepam, digoxin, digoxin immune Fab (ovine), diphenhydramine, dobutamine, dopamine, eculizumab, efavirenz, enalaprilat, entecavir, epinephrine (adrenaline), epoetin alfa, erythromycin, esmolol, esomeprazole, famotidine, fentanyl, fluconazole, flumazenil, flunisolide, fluoxetine, fluticasone, fluticasone/salmeterol, fluvoxamine, fosphenytoin, furosemide, gentamicin, glyburide, guanfacine, hepatitis B vaccine (recombinant), hydralazine, hydrocodone/acetaminophen, hydrocodone/ibuprofen, hydrocortisone, hydromorphone, hydroxyzine, imipenem/cilastatin, immune globulin (human), infliximab, itraconazole, ivermectin, lamivudine, lamotrigine, levalbuterol, levetiracetam, levofloxacin, lidocaine - antiarrhythmic, lidocaine - CNS, linezolid, lorazepam, losartan, measles, mumps, rubella (MMR) virus vaccine (live), measles, mumps, rubella, varicella (MMRV) vaccine, meropenem, metformin, methadone, methylprednisolone, metronidazole, miltefosine, morphine, naloxone, nevirapine, nicardipine, nifedipine, omeprazole, oseltamivir, oxacillin, oxcarbazepine, oxycodone, oxycodone/acetaminophen, oxycodone/ibuprofen, palonosetron, paroxetine, penicillin g, penicillin G benzathine/penicillin G procaine, pentobarbital, piperacillin/tazobactam, poliovirus vaccine enhanced-inactivated, prednisolone, prednisone, risperidone, rotavirus vaccine (Rotarix®), rotavirus vaccine (RotaTeq®), salmeterol, sodium glycerophosphate, sumatriptan, sumatriptan/naproxen, ticarcillin/clavulanate, tobramycin, tramadol, trimethoprim/sulfamethoxazole, valganciclovir, valproic acid and derivatives, vancomycin, varicella virus vaccine (live), voriconazole, zanamivir, zidovudine, zolmitriptan
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