Hospital Drug Burden and Post‐Discharge Health Care Utilization in Older Adults Prescribed Central Nervous System‐Active Medications

BACKGROUND: The Drug Burden Index (DBI) quantifies cumulative exposure to anticholinergic and sedative medications and can be used to measure medication burden during hospitalization. This study evaluates using automated DBI calculations from electronic health records (EHRs) to track DBI changes during hospitalization, identify high-risk older adults, and assess associations with post-discharge health utilization outcomes. METHODS: This retrospective cohort study used EHRs of patients aged 65+ from three academic health system hospitals (2018-2020), and prescribed central nervous system (CNS)-acting medications around hospitalization (90 days before and after). Logistic regression assessed the associations between DBI at admission, discharge, and changes in DBI during hospitalization with 30-day readmission and discharge destination. Linear regression assessed the relationship between DBI at these time points and 90-day post-discharge outpatient visits. RESULTS: A total of 3450 eligible patients had complete DBI measurements, with 80% having no change during hospitalization. DBI at admission, discharge, or changes during hospitalization was not associated with 30-day readmission. Any change in DBI, compared to no DBI change, was associated with reduced odds of being discharged home (DBI increase [worsening drug burden] OR: 0.29 [0.21, 0.40]); DBI decrease OR: 0.35 [0.28, 0.43]. High DBIs at admission or discharge were linked to more clinical visits post-discharge, while a DBI increase during hospitalization was associated with fewer visits (RR: 0.86 [0.73-1.00]). CONCLUSION: DBI changes during hospitalization impact discharge disposition and follow-up care needs but not 30-day readmission, highlighting opportunities to optimize medication management during hospitalization.