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Purpose: Readmission prediction indices are used to stratify patients by the risk of hospital readmission. We describe the integration of a 30-day hospital readmission prediction index into the electronic medical record (EMR) and its impact on pharmacist interventions during transitions of care (TOC)., Methods: A retrospective cohort study was conducted to compare 30-day readmission rates between adult internal medicine inpatients admitted by a multidisciplinary team providing TOC services (the TOC group) and those who received usual care (the control group). Interventions by a pharmacist serving on the TOC team were guided by an EMR-integrated readmission index, with patients at the highest risk for readmission receiving targeted pharmacist interventions. Inpatient encounters (n = 374) during the 5-month study period were retrospectively identified. Chi-square and Mann-Whitney U tests were performed to analyze differences in nominal and nonparametric continuous variables, respectively. Logistic regression was performed to identify variables associated with 30-day readmissions. The log-rank test was used to analyze hazard ratios for readmission outcomes in the 2 cohorts., Results: Thirty-day readmission rates did not differ significantly in the TOC group and the control group (20.9% vs 18.3%, P = 0.52). However, patients who received additional direct pharmacist interventions, as guided by use of a hospital readmission index, had a lower 30-day readmission rate than patients who did not (11.4% vs 21.7%, P = 0.04). The readmission index score was significantly associated with the likelihood of 30-day readmission (odds ratio for readmission, 1.25; 95% confidence interval, 1.16-1.34; P < 0.01). The difference in unadjusted log-rank scores at 30 days with and without pharmacist intervention was not significant (P = 0.05). A mean of 4.5 medication changes were identified per medication reconciliation performed by the TOC pharmacist., Conclusion: A multidisciplinary TOC team approach did not reduce the 30-day readmission rate on an internal medicine service. However, patients who received additional direct pharmacist interventions guided by a readmission prediction index had a reduced readmission rate., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The study derives and validates a 30-day hospital readmission risk index to predict a patient's likelihood of readmission, utilizing a health systems electronic medical record., Methods: A retrospective data extraction and analysis was conducted using data from the electronic medical record to identify risks of 30-day all-cause hospital readmission on adult patients admitted to a large multi-site health system. Univariate and multivariable logistic regression was performed on a derivation cohort of hospital admissions (n = 40,668) and analyzed 91 variables associated with 30-day hospital readmission. A 10-variable risk prediction equation was generated and validated in a second patient cohort (n = 7,820). The prediction index's discriminative ability was determined using the c-statistic, and calibration of the prediction index was assessed with the use of the Hosmer-Lemeshow test., Results: The hospital all-cause thirty-day readmission index (HATRIX) identified 10 variables to be highly associated with 30-day readmission. The discriminative ability of the derived prediction equation was determined using the c-statistic and was calculated to be 0.73 (95% confidence interval [CI] 0.72-0.73) for the derivation cohort. The prediction equation was validated using a second cohort of patients and resulted with an area under the curve (AUC) of 0.72 (95% CI 0.70-0.73), indicating modest discrimination., Conclusion: An original risk prediction index for 30-day hospital readmission was derived and validated using 2 cohorts of patients. Identifying patients who have an increased risk of 30-day hospital readmission with the use of the electronic medical record is an ideal method for targeting interventions and improving transitions-of-care to reduce hospital readmissions., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: A study was conducted to determine if an iterative validation process could maintain or improve the discriminative and predictive capabilities of a 30-day hospital readmission prediction index over 2.5 years., Methods: Patient admissions were retrospectively identified using the electronic medical record. The receiver operating characteristic curve was used to assess model discrimination. Prediction index specificity, sensitivity, and positive and negative predictive values were also assessed. A rolling iterative validation process was developed in which patient admissions were divided into 3-month cohorts. Each cohort was analyzed individually and then included into the cumulative patient cohort and analyzed again., Results: From 121,277 patient visits, an iterative validation approach maintained the discrimination (0.71 to 0.72), predictive validity, and overall accuracy (80.9% to 81.7%) of the 30-day readmission prediction index over 2.5 years. Index sensitivity and negative predictive value increased from baseline while specificity and positive predictive value remained largely unchanged. None of the assessed index parameters diminished or became less useful over the course of the study., Conclusion: An internal iterative validation process based on frequentist statistics maintained the discriminative ability and accuracy of a readmission index over 2.5 years despite numerous changes in the variables associated with readmission in the patient population., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The mechanism of action, pharmacology, pharmacokinetics, clinical efficacy, drug interactions, adverse effects, dosage and administration, cost, and role in therapy of maraviroc are reviewed., Summary: Maraviroc is the first CCR5 coreceptor antagonist to receive marketing approval from the Food and Drug Administration (FDA) for the treatment of CCR5-tropic human immunodeficiency virus (HIV) infection as part of an optimized antiretroviral regimen in treatment-experienced patients. As 50% or more of treatment-experienced patients may be infected with CXCR4-tropic virus, a tropism assay should be performed before initiating maraviroc therapy. The majority of evidence supporting maraviroc's use comes from two studies of HIV-infected, treatment-experienced patients. Pooled analysis from these two studies revealed that twice-daily maraviroc decreased HIV-1 RNA by 1.84 log copies/mL, compared with 0.78 log copy/mL with placebo. Forty-six percent of subjects attained an HIV-1 RNA concentration of <50 copies/mL, compared with only 17% with placebo. In a trial of treatment-naive HIV-infected individuals, maraviroc failed to show noninferiority to efavirenz. Maraviroc is metabolized by cytochrome P-450 isoenzyme 3A4 and is subject to interactions with inhibitors and inducers of that isoenzyme, such as the protease inhibitors (except tipranavir), efavirenz, and rifampin. Resistance has been reported with maraviroc, but specific mechanisms are still poorly understood. The most common adverse effects reported with maraviroc were diarrhea, nausea, fatigue, and headache., Conclusion: Available data support the use of maraviroc, the first CCR5 antagonist to receive FDA marketing approval, as part of an optimized antiretroviral regimen in treatment-experienced patients infected with CCR5-tropic HIV.