About me
Background/Purpose: In July 2022, AdventHealth Apopka initiated percutaneous coronary intervention services, prompting an interest in the overall performance and care quality of PCI patients. While recommended process metrics by ACC/AHA exist, past researchers have been further examining the relationship between process and outcome metrics for better care assessment. A 2017 analysis found a 12% readmission rate within 30 days for PCI patients, highlighting the burden on patients and healthcare systems. Additionally, CMS has adopted 30-day all-cause readmission rates as a key metric for acute myocardial infarctions and cardiovascular procedures, including PCI. Our goal is to identify areas for improvement in our PCI program by analyzing patient outcomes, especially 30-day readmission rates, in patients who have received PCI. Research has been done on pharmacy-led discharge counseling and its impact on hospital readmission and ED visits. However, these studies have been shown to have mixed results. A 2017 meta-analysis consisting of seventeen studies showed that pharmacist-led care for patients upon discharge following ACS events did not demonstrate notable improvements in medication adherence or notable reductions in subsequent readmissions, emergency department visits, or mortality. Insights from this research can benefit other healthcare institutions in enhancing care for PCI patients by applying these findings to improve care.
Methods: This was a retrospective chart review conducted at AdventHealth Apopka. The study population includes patients undergoing PCI at AdventHealth Apopka from August 1, 2022, to July 31, 2023, focusing on those aged 18 or older who received emergent or elective PCI procedures with stent placement. Excluded are patients without a stent during PCI or those treated outside the specified timeframe. The primary outcome will evaluate the 30-day readmission rates of patients post-PCI at AdventHealth Apopka. Secondary outcomes will assess 30-day readmission rates of patients who received post-PCI medication education from pharmacy personnel, incidence of 30-day all-cause mortality post-PCI, rate of both 30-day and 90-day medication adherence in patients who received post-PCI medication education from pharmacy personnel, incidence of all-cause mortality during PCI encounter, incidence of AKI events in patients who received both IV and PO P2Y12-inhibitors during PCI encounter, and lastly the incidence of major/minor bleeding in patients who received both IV and PO P2Y12-inhibitors during PCI encounter. Conventional statistical analysis methods will be utilized to assess outcomes.
Results: Results from our study reveal that among the 131 patients who underwent percutaneous coronary intervention (PCI) with stent placement, 9.2% were readmitted within 30 days post-procedure. Furthermore, of the same cohort, 57 patients received PCI education, with 8.8% of them experiencing readmission within 30 days. Additionally, within the educated subgroup, medication adherence rates at 30 and 90 days were 75% and 60%, respectively. Regarding adverse events when both intravenous and oral P2Y12 are utilized, our findings indicate rates of 1.6% for both acute kidney injury and major/minor bleeding. Thirty-day all-cause mortality rate of patients who received PCI was 3%.
Conclusions: In summary, our evaluation of the PCI program revealed promising results, with metrics for 30-day mortality and adverse events, including AKI and major bleeding, meeting national averages as per existing literature. However, despite this apparent success, it is important to acknowledge the need for continued investigation into maximizing the pharmacist's role in education consultations. Further investigation into the discharge planning/turnover time of post-PCI patients, the availability and workload of pharmacists on the weekends, and the potential use for a dedicated pharmacy staff member can be explored. This study is not without limitations, notably its retrospective design, potential documentation bias, and constraints within the electronic health record system hindering a comprehensive assessment of medication adherence. Future research should aim to address these limitations to provide a more thorough evaluation of the PCI process and the pharmacist's role in medication management and education within our institution.
