Hospital readmissions are an indicator of quality of care. To assess whether medication reviews with an extensive set of clinical rules can help to reduce the number of readmissions, we plan to perform a randomised, multicenter, transmural trial comparing medication review with clinical rules versus care as usual. The objective is to reduce the number of readmissions in older patients from 20% to 15%. For the Netherlands this may translate into the prevention of 15.600 hospital readmissions per year among patients aged 60 years and over (based on pilot study).
The study is a prospective multicenter (3 locations) randomised controlled trial with randomisation at patient level in intervention and usual care group. The study population consists of patients admitted unplanned to the hospital and fulfilling the following criteria: aged 60 years and over, polypharmacy and at least two signals from the trigger list. In total 1200 patients will be included per group (power 80%; significance level 5%; ICC 0.05; drop-out 20%).
In the intervention group a structured medication review will be performed by a software program (clinical rule reporter, CRR). The CRR analyses the patient’s characteristics, medication, medical history and lab data. The CRR contains more than 500 different clinical rules. The result of the CRR will be presented to GP/community pharmacist. After discharge the CRR will analyze the medication of the patient each week.
The primary endpoint is the number of readmissions during the year after admission. An economic evaluation and quality of life analysis is part of the proposal.
The feasibility of the project is increased as the software is already up and running, the 3 hospital locations form a closed area and the research group has a multidisciplinary character including patients.
Based on the calculations we expect to save between €26.5 and €32.7 M when this intervention is implemented Nationwide.