Effect of Medication Adherence and Early Follow-Up on Unplanned Readmission Post-Myocardial Infarction: Quality Improvement in a Safety Net Hospital. Issue 2 (June 2021)

• Record Type: Journal Article
• Authors: Ashraf, Hassan; Warren, Elizabeth; Latner, Joshua P.; Shah, Khanjan B.; Bell, Jessica; Lowe, Sarah; Phillips, Rose G.; Martinez, Kimberly; Pommett, Catherine; Lindsay, Tammy; Adkins, Jacqueline; Sheffield, Lauren; Richter, Julie; Keeley, Ellen C.
• Is Part Of: Critical pathways in cardiology. Volume 20:Issue 2(2021)
• Publication Date: 2021-06
• Subjects: medication adherence -- post-myocardial infarction -- unplanned readmission; Cardiology -- Periodicals; Evidence-based medicine -- Periodicals; Medical protocols -- Periodicals; 616.12005
• DOI: 10.1097/HPC.0000000000000231
• Languages: English
• ISSNs: 1535-282X

Abstract

Abstract : Medication nonadherence is a strong predictor of adverse events and unplanned 30-day readmissions in post-myocardial infarction (MI) patients. Nonadherence with dual antiplatelet therapy (DAPT) is of particular concern in post-MI patients, given the high rate of percutaneous coronary intervention in this population. Review of post-MI quality measures revealed that compared to national benchmarks, our safety net hospital had lower DAPT adherence rates and higher unplanned 30-day readmission rates. The aim was to improve these important quality measures by creating a transition of care pathway primarily focused on medication accessibility and affordability of DAPT and early follow-up. A multidisciplinary task force created a transition of care pathway that included bedside medication delivery, patient assistance program enrollment for medications, and follow-up within 10 days of discharge in a dedicated post-MI clinic. Resources for the pathway (personnel and hospital) were already available and repurposed. We compared quality measures of DAPT adherence, proportion of patients evaluated early after hospital discharge, and unplanned 30-day readmissions before and after the initiative. Following initiation of the transition of care pathway, DAPT adherence increased from 56% pre-intervention to 92% post-intervention ( P < 0.0001). The proportion of patients scheduled for early clinic follow-up after discharge increased and unplanned 30-day readmissions decreased following initiation of the pathway. A transition of care pathway for post-MI patients using readily available resources was associated with increased DAPT adherence and decreased 30-day unplanned readmissions.