Complexity index could help hospital readmission, allow early action

Is it possible to predict which hospital patients will be readmitted within 30 days after discharge because of a problem with their prescription drugs?

Clinical Assistant Professor Megan Willson and two colleagues studied a year’s worth of data from Spokane’s four hospitals and added their observations to the ongoing national discussion by recently publishing a paper in the Annals of Pharmacotherapy.

“What surprised me was that the medication added during the hospital stay was not a factor that significantly affected the readmission rate,” Willson says. “The primary predictor of a readmission was the overall complexity of the patient’s home medication regimen.”

There is more than one definition of medication complexity being used in this type of research, and the medication regimen complexity index Willson and her colleagues used included number of medications, number of times per day the medications were to be taken as well as route of administration and additional directions. They assigned medication complexity scores to regimens to determine if the scores would predict which patients might be at risk for hospital readmission due to an adverse drug event. They did.

Willson and her co-authors concluded that the complexity of a medication regimen is a good target for efforts to try to prevent readmission to the hospital. Those efforts could include hospital pharmacists reviewing medications and talking with patients about their medication habits, their adherence to taking drugs as prescribed and helping patients understand their diseases.

Willson’s research project touches every aspect of her professional life with WSU. First, she is the pharmacist on the internal medicine patient care team at Providence Sacred Heart Medical Center in Spokane, where she provides patient care, manages discharge regimens and mentors pharmacy students and pharmacy residents. In the classroom at WSU, Willson teaches pharmacy students the very communications skills pharmacists need to learn to talk with people from different age groups and cultures and backgrounds about taking their medications correctly and about their diseases.

“What I really like about my job is that it is always changing,” Willson said. “There are new patients, new questions, new problems. One day I am teaching and the next day I am talking to patients.”

Willson was age 17 when she shadowed a physician because she was interested in medicine, and among the topics he covered was pharmacy. Then her mother encouraged her to look into the field, and when they toured the St. Louis College of Pharmacy in her home state of Missouri, it felt like a good fit for her.

After graduating with her Doctor of Pharmacy, she completed a residency at St. Luke’s Hospital in Chesterfield, Mo. She and her husband moved to Spokane seven years ago when she took her job with WSU. Willson also is an active member of the Human Patient Simulation team where the faculty explore various ways to use manikins in their teaching.

Willson’s co-authors on her paper were Christopher L. Greer, a pharmacist at St. Luke’s Rehabilitation Institute in Spokane, and Douglas L. Weeks, a senior research investigator at Inland Northwest Heath Services.