Implementation of a clinical pharmacy specialist-managed telephonic hospital discharge follow-up program in a patient-centered medical home

Popul Health Manag. 2013 Aug;16(4):235-41. doi: 10.1089/pop.2012.0070. Epub 2013 Mar 28.


The objectives of this retrospective study were to examine the feasibility and characteristics that define successful implementation of a Clinical Pharmacy Specialist (CPS) telephonic hospital discharge follow-up quality improvement initiative, as well as the impact of this initiative. Adult patients who were discharged from a safety-net hospital between July 1, 2010 and June 30, 2011 and who were part of a patient-centered medical home were included in this quality improvement initiative. CPSs attempted to contact 470 patients; of those, 207 received the intervention and 263 did not. Patients in the contacted group were more likely to attend a hospital discharge follow-up appointment (66.2% vs. 44.5%, P<0.01) and had lower rates of 30-day readmission (22 vs. 52, P<0.01) compared to those who were not contacted. Institutions should consider allocating resources for pharmacist-managed posthospital discharge follow-up services because of the potential for positive clinical and financial impact.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care / organization & administration*
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay / trends
  • Male
  • Middle Aged
  • Patient Discharge / trends
  • Patient Readmission / trends
  • Patient-Centered Care / methods*
  • Pharmacy Service, Hospital / organization & administration*
  • Professional Role
  • Retrospective Studies
  • Specialization*
  • Telephone
  • United States
  • Young Adult