Table 1, Chapter 25Studies of medication reconciliation that include assessment of clinically significant unintended discrepancies and emergency department visits and hospitalizations within 30 days of discharge

StudySettingStudy DesignTransition TargetedAdditional Interventions Beyond Medication ReconciliationOutcome
Coffey, 200918Pediatric ward in academic medical center in CanadaProspective post-intervention study (272 patients)Admission to hospitalNoneClinically significant unintentional discrepancies
Cornish, 20052Medical ward in academic medical center in CanadaProspective post-intervention study (151 patients)Admission to hospitalNoneClinically significant unintentional discrepancies
Gleason, 200419Surgical and medical wards in U.S. academic medical centerPost-intervention study (204 patients, 12 adult medical-surgical units)Admission to hospitalNoneClinically significant unintentional discrepancies
Gleason, 201020Medical ward in U.S. academic medical centerProspective post-intervention study (651 patients)Admission to hospitalNoneClinically significant unintentional discrepancies
Kripalani, 201221Medical and cardiology wards in two U.S. academic medical centersRCT (428 patients)At time of enrollment in study, discharge home, and in-hospital transferDischarge counselingClinically significant unintentional discrepancies
Kripalani, 201221Medical and cardiology wards in two U.S. academic medical centersRCT (423 patients)At time of enrollment in study, discharge home, and in-hospital transferPharmacist intervention including in-patient pharmacist counseling, low-literacy adherence aids, and post-discharge phone callClinically significant unintentional discrepancies
Lee, 20105Inpatient wards and critical care units in two academic medical centers in CanadaProspective post-intervention study (129 patients, 10 patient care units)In-hospital transferNoneClinically significant unintentional discrepancies
Pippins, 200822Medical wards in two U.S. academic medical centersProspective post-intervention study (180 patients, 7 medical teams)Discharge homeNoneClinically significant unintentional discrepancies
Stone, 201023Pediatric ward in U.S. academic medical centerProspective post-intervention study (23 patients on 2 medical teams)Admission to hospitalNoneClinically significant unintentional discrepancies
Vira, 200624Acute care units in urban community hospital in CanadaRetrospective post-intervention study (60 patients)Admission to hospital; discharge homeNoneClinically significant unintentional discrepancies
Wong, 20084Medical ward in academic medical center in CanadaProspective post-intervention study (150 patients)Discharge homeNoneClinically significant unintentional discrepancies
Schnipper, 200925Medical wards in two U.S. academic medical centersRCT (162 patients, 7 medical teams)Admission to hospital; discharge homeNoneClinically significant unintentional discrepancies

Emergency department visits and hospitalizations within 30 days of discharge
Dedhia, 200926Medical wards in U.S. academic medical center, community teaching hospital, and urban community hospitalProspective before-after study (185 patients)Discharge homeSafe STEPS intervention including admission assessment, communication with PCP, multidisciplinary discharge meetingEmergency department visits and hospitalizations within 30 days of discharge
Jack, 200927Medical ward in U.S. academic medical centerRCT (373 patients)Discharge homeNurse discharge advocates created after-hospital care plan, and post-discharge phone callEmergency department visits and hospitalizations within 30 days of discharge
Koehler, 200928Medical ward in U.S. academic medical centerRCT (21 patients, 2 hospital-medicine groups)Admission to hospital, discharge homeCounseling by registered nurseEmergency department visits and hospitalizations within 30 days of discharge
Koehler, 200928Medical ward in U.S. academic medical centerRCT (20 patients, 2 hospital-medicine groups)Admission to hospital, discharge homeSupplemental elderly care bundle: counseling by pharmacist, post-discharge phone call, discharge letter to PCPEmergency department visits and hospitalizations within 30 days of discharge
Kramer, 200729Medical ward in U.S. community teaching hospitalProspective before-after study (136 patients)Admission to hospital; discharge homeNoneEmergency department visits and hospitalizations within 30 days of discharge
Schnipper, 200630Medical ward in U.S. academic medical centerRCT (92 patients, 4 medical teams)Discharge homeNoneEmergency department visits and hospitalizations within 30 days of discharge
Showalter, 201131All admitted patients through emergency department in U.S. academic medical centerRetrospective before-after study (17,516 patients)Discharge homeStandardized mandatory electronic discharge instructions document with embedded computerized medication reconciliationEmergency department visits and hospitalizations within 30 days of discharge
Walker, 200932Medical ward in U.S. academic centerProspective quasi-experimental study (358 patients, 2 medical teams and 1 hospitalist service)Discharge homePharmacist-facilitated discharge program including counseling, provision of medication reconciliation list to PCP, and post-discharge phone callEmergency department visits and hospitalizations within 30 days of discharge

Abbreviations: RCT, randomized control trial; PCP, primary care physician; Safe STEPS, Safe and Successful Transition of Elderly Patients Study.

From: Chapter 25, Medication Reconciliation Supported by Clinical Pharmacists (NEW)

Cover of Making Health Care Safer II
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 211.

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