2015 Finalist: University of Illinois Hospital & Health Sciences System

Chicago, IL
Novel Pharmacist Led Personalized Medicine Program Improves Patient Safety, Clinical and Health-Care Utilization Outcomes


Background
Precision or personalized medicine, specifically incorporation of genetic information into the therapeutic decision-making and patient-monitoring processes should optimize medication use, reduce failure rates of initial treatment and improve clinical and healthcare utilization outcomes.

Historical data and a gap analysis indicated that adverse events related to narrow therapeutic index and high-alert medications constituted a major segment of emergency department (ED) and hospital readmissions at University of Illinois Hospital & Health Sciences System (UI-Health). Beginning in 2012, UI-Health implemented a pharmacist-led, interdisciplinary Personalized Medicine Program. The UI-Health’s Personalized Medicine Program was established with the goal to improve targeted high-alert medication safety, as well as related clinical and healthcare utilization outcomes.

Pharmacist Leadership
Pharmacists have taken a leadership role in program needs assessment; design; implementation; staff education; provision of direct patient care; and quality and outcomes data tracking, analysis and dissemination.

Methods
The program has a broad scope that extends throughout the health system (inpatient, transitions of care, outpatient) and includes multiple components of the medication-use process. Four high-alert therapeutic areas were targeted, with antithrombotics being the first to be fully implemented.

The program operates 7 days a week and is a pharmacy-led interdisciplinary effort that is collaboratively supported by medicine, cardiology, hematology, molecular pathology, information technology and health-system administration. Health informatics and clinical decision support (CDS) tools were built into our EHR to trigger automatic alerts and orders for genotyping and the pharmacist-led personalized medicine consult service.

Results
To date, more than 800 patients have been genotyped (warfarin and clopidogrel) as part of our Phase I program implementation. Our results suggest that the pharmacist-led personalized medicine service has resulted in improved safety, clinical and healthcare utilization outcomes and cost savings. A total of 697 consecutive patients were included in analyses, 389 patients in the intervention group and 308 in the control group. Results of the intervention group compared to the control group included:
  • A 77-percent lower incidence of 30-day postdischarge hospital readmissions due to therapy-related complications (RR 0.23, 95%CI 0.05 – 1.09; p=0.06).
  • A 68-percent lower incidence of 90-day postdischarge hospital readmissions due to therapy-related complications (RR 0.32, 95% CI 0.12 – 0.82; p=0.01).
  • The 90-day absolute risk difference from a propensity-adjusted model was 2.4 percent, with the number needed to treat at 41 in order to avoid one therapy-related hospital readmission.
  • The estimated annualized medical cost savings for the program were $596,272.8, or $2,043.78 saved per patient managed by the personalized medicine service, which support sfuture program sustainability.
Conclusion
Implementation of a pharmacist-led personalized medicine service at UI-Health has resulted in improved safety, clinical and healthcare utilization outcomes and cost savings. The standardized components of the program may be exported to other institutions interested in implementing similar programs. In addition, the interdisciplinary approach to the UI-Health program represents a model for team-based care, including pharmacists, physicians, health-system administrators, bioinformaticians and laboratory personnel. In line with ASHP’s statement on the pharmacist’s role in clinical pharmacogenomics, our program highlights how pharmacists are uniquely positioned to lead such novel interdisciplinary efforts and the positive value of these efforts in impacting safe medication use.

Interprofessional Team

Edith Nutescu, Pharm.D., M.S.
Julio Duarte, Pharm.D., Ph.D.
Supatat Chumnamwat, Pharm.D., BCPS
William Galanter, M.D., M.S., Ph.D.
James Lee, Pharm.D., BCACP
John Garofalo, Pharm.D.
David Peace, M.D.
Tom Stamos, M.D.
Surrey Walton, Ph.D.
Jerry Krishnan, M.D., Ph.D.
Jerry Bauman, Pharm.D.
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