Abstract
Background/Aim: Patient engagement in healthcare is potentially important for moderating risks for adverse events and rehospitalization during hospital-to-home transitions. However, little is known about whether patients’ behaviors actually impact outcomes following hospital discharge. The aim of this study was to describe the impact of medication adherence on risk for rehospitalization and ER visits following hospitalization for Medicare beneficiaries enrolled in a Medicare cost contract HMO offered by Scott & White Health Plan.
Methods: Claims data from June 2006 to June 2008 were selected for all SeniorCare patients who had at least one hospitalization during 2007. The first hospitalization of the year was considered the index hospitalization. Medication adherence in the six months prior to index hospitalization was estimated using the Medication Possession Ratio (MPR). Time to rehospitalization and time to ER visit were calculated from the index hospitalization date of discharge to the event date or last follow-up date.
Results: The analysis included 3,729 members with at least one hospitalization during 2007. Median age was 78 (range 27 – 105) and 57% of those patients were female. The cumulative incidence of rehospitalization at 6 months was 12.2% (95% confidence interval = 11.1%, 13.4%). The cumulative incidence of ER visits at 6 months was 21.2% (95% Confidence Interval = 19.8%, 22.7%). Median MPR in the six months prior to the index hospitalization was 0.85 (range 0.01 – 1) with 62% of patients with MPRs representative of “high” adherence to prescribed medications. Medication adherence was not significantly associated with rehospitalization or ER visits following hospitalization.
Conclusion: Most guidelines and interventions for care transitions following hospitalization emphasize the important role of patient or family health behaviors, including medication adherence. No evidence was found that supports the hypothesis that history of adherence to medications is associated with a reduced risk for rehospitalization or ER use. Prospective studies of patient health behaviors during hospital transitions are needed to better understand the impact of patient health behaviors during the time following hospitalization.
- Received May 27, 2010.
- Accepted May 27, 2010.
