MODELS OF GERIATRIC CARE, QUALITY IMPROVEMENT, AND PROGRAM DISSEMINATION Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events Sandra L. Kane-Gill, PharmD, MSc,* † Adrian Wong, PharmD, MPH,* ‡ Colleen M. Culley, PharmD,* † Subashan Perera, PhD, FGSA, ‡§ Maureen D. Reynolds, PhD,* Steven M. Handler, MD,PhD, ‡¶ John A. Kellum, MD, ∥ Monica B. Aspinall, PharmD,** Megan E. Pellett, PharmD,** Keith E. Long, PharmD,* David A. Nace, MD, ‡ and Richard D. Boyce, PhD ¶ BACKGROUND/OBJECTIVES: Federally-mandated con- sultant pharmacist-conducted retrospective medication regi- men reviews (MRRs) are designed to improve medication safety in nursing homes (NH). However, MRRs are poten- tially ineffective. A new model of care that improves access to and efficiency of consultant pharmacists is needed. The objective of this study was to determine the impact of phar- macist-led telemedicine services on reducing high-risk medi- cation adverse drug events (ADEs) for NH residents using medication reconciliation and prospective MRR on admis- sion plus ongoing clinical decision support alerts through- out the residents’ stay. DESIGN: Quality improvement study using a stepped- wedge design comparing the novel service to usual care in a one-year evaluation from November 2016 to October 2017. SETTING: Four NHs (two urban, two suburban) in South- western Pennsylvania. PARTICIPANTS: All residents in the four NHs were screened. There were 2,127 residents admitted having 652 alerts in the active period. INTERVENTION: Upon admission, pharmacists con- ducted medication reconciliation and prospective MRR for residents and also used telemedicine for communication with cognitively-intact residents. Post-admission, pharma- cists received clinical decision support alerts to conduct targeted concurrent MRRs and telemedicine. MEASUREMENT: Main outcome was incidence of high- risk medication, alert-specific ADEs. Secondary outcomes included all-cause hospitalization, 30-day readmission rates, and consultant pharmacists’ recommendations. RESULTS: Consultant pharmacists provided 769 recommen- dations. The intervention group had a 92% lower incidence of alert-specific ADEs than usual care (9 vs 31; 0.14 vs 0.61/1,000-resident-days; adjusted incident rate ratio (AIRR) = 0.08 (95% confidence interval (CI) = 0.01–0.40]; P = .002). All-cause hospitalization was similar between groups (149 vs 138; 2.33 vs 2.70/1,000-resident-days; AIRR = 1.06 (95% CI = 0.72–1.58); P = .75), as were 30-day readmissions (110 vs 102; 1.72 vs 2.00/1,000-resident-days; AIRR = 1.21 (95% CI = 0.76–1.93); P = .42). CONCLUSIONS: This is the first evaluation of the impact of pharmacist-led patient-centered telemedicine ser- vices to manage high-risk medications during transitional care and throughout the resident’s NH stay, supporting a new model of patient care. J Am Geriatr Soc 00:1-9, 2020. From the *School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania; † Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania; ‡ Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; § Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania; ¶ Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; ∥ Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and the **RxPartners Inc., UMPC Diversified Services, Bridgeville, Pennsylvania. Present address: Adrian Wong, Department of Pharmacy Practice, MCPHS University, Boston, Massachusetts, USA; Adrian Wong, Department of Pharmacy Practice, MCPHS University, Boston, Massachusetts, USA Address correspondence to Sandra L. Kane-Gill, PharmD, MSc, FCCM, FCCP, University of Pittsburgh, School of Pharmacy, PRESBY/SHY Pharmacy Administration Building, 3507 Victoria St., Mailcode PFG- 01-01-01, Pittsburgh, PA 15213. E-mail: kane-gill@pitt.edu DOI: 10.1111/jgs.16946 JAGS 00:1-9, 2020 © 2020 The American Geriatrics Society 0002-8614/20/$15.00