The transition from hospital to primary care is a high-risk period for patients due to complex communication among multiple health care professionals, frequent medication changes, and complex care plans [1]. These factors increase the likelihood of medication harm and hospital readmission [2]. Implementing a structured transition of care (TOC) service with tailored support may help mitigate these risks [3,4].

Cardiovascular disease remains one of the leading causes of mortality in Australia and is managed with high-risk medications, such as anticoagulants and antiplatelets, that require careful titration [5,6]. These medications are a major contributor to medication harm, leading to medication-related hospital readmissions, morbidity, and mortality [5]. Associated complications include bleeding, acute kidney injury, hypotension-related falls, and electrolyte disturbances. Patients recovering from acute myocardial infarction (AMI) or cardiothoracic surgery (CS) are particularly vulnerable [6,7]. A previous study by the authors found that 6% (94/1564) of post–myocardial infarction patients were readmitted due to severe medication harm [5]. Another Australian study reported that 93% of cardiology unit discharges involved at least one medication-related problem, often linked to uncertainty about medications, drug interactions, and adverse effects [8].

Health inequities further exacerbate adverse cardiovascular outcomes. A dedicated TOC practitioner, trained in medication management, who can advocate for and provide timely navigation for patients as they return to the community remains a significant gap for some of these specialized high-risk patient groups [9]. For instance, in Queensland, hospital programs such as Better Cardiac Care for Aboriginal and Torres Strait Islander teams have improved aspects of medication management, such as ensuring medication supply and improving discharge communication [7,10-13]. Systemic inequities, treatment complexity, and limited access to culturally safe or patient-tailored services likely heighten risks, necessitating tailored, co-designed TOC interventions, as we propose.

Current health care systems are not adequately designed to support patients postdischarge, highlighting the need for a multifaceted approach to improve medication management at TOC [14]. Postdischarge care is often hindered by inadequate communication channels, a lack of early engagement with patients and carers, and difficulty scheduling follow-up with general practitioners (GPs) [15]. Up to 50% of patients lack a regular GP or community pharmacist, which further compromises continuity of care [15]. Given the medication burden and complex health care needs of the post-AMI and CS population, a formal TOC approach with a pharmacist leading an interdisciplinary team is vital to improving outcomes and reducing readmissions. Pharmacist-led TOC services have been shown to reduce readmissions and medication harm while maximizing quality of life for cardiovascular patients [2]. A hospital-initiated, pharmacist-led multidisciplinary approach facilitates improved medication management by encouraging patient and caregiver engagement, development of shared care plans, and collaboration with health care professionals [16]. While existing programs address heart failure and cardiac rehabilitation [17], no dedicated initiatives focus on postdischarge medication management for high-risk patients following an AMI or CS event.

Community-based medication review programs, such as Home Medication Reviews and Residential Medication Management Reviews, provide some support but are not tailored for patients recently discharged after an AMI or CS [18]. These programs are also underutilized by Aboriginal and Torres Strait Islander peoples and those in rural and remote areas and are not always available in a timely manner for immediate postdischarge care [9]. The current TOC model relies heavily on written communication to GPs, which may not be received in time for actions to be taken and is not consistently shared with community pharmacists for their active clinical involvement [19]. Geographic barriers and limited health care access further hinder timely follow-up, increasing the risk of medication harm. The members of a TOC team can act as patient advocates, ensuring effective communication and timely care coordination postdischarge. Pharmacists are uniquely positioned to perform this role for high-risk patients due to the medication misadventure risks they face during TOC.

The TOC service to RECARD (Reduce Hospital Readmissions for High-Risk Cardiology Patients) patients is a program that will codevelop, implement, and evaluate a patient-centered, pharmacist-led, interdisciplinary TOC service to reduce medication-related hospital readmissions in patients following AMI and CS. There is no existing evidence-based framework that systematically addresses medication harm at TOC for this cohort. There is an urgent need for a structured, patient- and team-centered TOC model that proactively identifies high-risk patients, engages them to co-design their care plans, ensures seamless communication among health care providers, and provides a home-based visit. This approach will integrate pharmacists into TOC teams that include nurses and Indigenous health workers to provide timely medication management support and improve patient outcomes.

Compared with usual care, the implementation of the interdisciplinary pharmacist-led TOC intervention will result in a significant reduction in 30-day medication-related hospital readmissions, be positively received by patients, and be cost-effective.

To evaluate the effectiveness of a pharmacist-led interdisciplinary TOC service in reducing medication-related hospital readmissions among cardiology patients following acute AMI or CS.

The study will be conducted in 2 phases: the development of the intervention using co-design principles (phase 1) and the pre-post interventional study (RECARD trial; phase 2).

This study will use a pre-post study that compares a retrospective historical cohort that received usual care and without a TOC service (precohort) to a prospective cohort that includes patients who receive either usual care or a pharmacist-led interdisciplinary TOC service (postcohort; Figures 1 and 2). During the poststudy period, patients identified as high risk will receive the individualized TOC service. These patients will be determined as those at the highest risk of medication-related hospital readmissions and will be termed “high-risk patients.” The rationale for delivering the TOC service intervention to high-risk patients is to ensure that those at greatest need (ie, risk of medication harm and readmission) are prioritized and thereby supporting long-term service sustainability.

The current local funding models do not allow every patient to receive an individualized service. We need to ensure a sustainable model of care that has the potential to be implemented and maintained within the Australian health care setting.

All patients admitted to the study sites with an index admission for AMI or CS between July 1, 2023, and June 30, 2024, will be included. A waiver of consent has been granted to collect these retrospective data for the historical usual care control group.

All patients admitted to the study sites with an index admission for AMI or requiring CS between December 2025 and November 30, 2026; the period when the interdisciplinary pharmacist-led TOC service will be implemented.

The inclusion criteria are as follows:

The exclusion criteria are as follows:

The intervention period will require prospective collection of data for patients in the intervention group, who will be consented before receiving the TOC service. Patients who receive usual care have a waiver of consent to collect inpatient data and readmission data (Figure 2).

Patients in the prestudy cohort will be retrospectively identified using the Health Information Management System reporting information and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10; or equivalent) data. In contrast, patients in the postcohort will be identified through the presenting diagnosis (AMI or CS) or through a confirmed diagnosis on completed angiograms as per clinical records.

In the poststudy cohort, only patients identified as high-risk of readmission, either by the risk prediction model or by referral from the treating team, will be offered the TOC service model. Patients who are not identified as high-risk will receive usual care.

Patient recruitment will be completed by the TOC pharmacist or a member of the research team after patient identification by a member of either the TOC team, the research team, or the local treating team.

High-risk patients will be identified using 2 methods:

Following patient consent, the TOC team will deliver assessments, activities, and medication reviews during the patient’s inpatient stay and for the 30 days postdischarge. The timeline for participant enrollment and assessments is shown in Table 1, created per the SPIRIT guidelines [23].

The RECARD activities will be described in an intervention bundle that is provided to support the decision-making capabilities of the TOC clinicians. Furthermore, this bundle is intended to empower TOC clinicians to make critical judgments when tailoring the TOC service to individual patients (eg, not repeating tasks that have been performed by ward pharmacists or not offering services that would be foreseeably ineffective).

The bundle will be developed based on previous work by the research team, including findings from a scoping review [1], local studies exploring TOC at the participating sites [33], and qualitative studies with clinicians and patients as part of the larger RECARD program (HREC/2023/MNHB/104151 [25]).

The work conducted in phase 1 seeks to inform the development of this bundle (see phase 1) [1]. The TOC service will be tailored to patients based on an assessment and identification of their individual needs and delivered during the hospital admission and across care transitions (Figure 3).

TOC services have many steps at which communication between patients and clinicians can occur (Figure 3). Table 1 highlights the potential touchpoints in the patient journey where various activities are provided to intervention participants as part of the TOC service. Typical activities delivered throughout a patient’s inpatient stay and in the postdischarge setting are described below [34]. The clinical skill set of NPs allows them to modify medication dosing, provide pathology requests, undertake patient observations, and interpret patient symptoms. In collaboration with the TOC pharmacist, the NP will run a 1-day-per-week clinic for patients who have specific comorbidities, pathology, physiology, or electrolytes requiring follow-up and patients with newly prescribed, withheld, or dose changes to β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker medications.

Medication education is defined as the provision of tailored counseling (ie, having a conversation with the patient and/or their caregiver about their medications) delivered by a health care professional [35]. This includes informing the patient of any changes to their medication regimen (ie, ongoing medications, new medications, changed medications, or discontinued medications). The provision of medication education can occur at any time point across the continuum of a patient’s health care [36]. Additionally, this TOC service will ensure that all written medication lists provided to the patient are communicated to both the patient’s GP and community pharmacy after their education with the RECARD pharmacist.

The TOC pharmacist, in liaison with a NP, will offer to provide lifestyle and, where required, disease-specific education, which may include counseling on modifiable risk factors such as diet, exercise, and smoking. This may also include the initiation or continuation of smoking cessation programs or nicotine replacement therapy, where appropriate. Disease-specific activities provided by the team may include further education on aspects such as symptom monitoring that are relevant to the patient’s cardiovascular condition (eg, salt intake or weight monitoring).

The TOC pharmacist will conduct a medication adherence assessment using 2 validated self-report tools, including the Medication Adherence Report Scale-5 [37,38]. An adherence assessment will be conducted as an inpatient activity (baseline) and as a postdischarge activity (follow-up). The adherence assessment will be used to tailor the information provided and identify interventions implemented for each individual identified as being at high risk of medication-related problems. If patients are assessed as nonadherent to their medications, the TOC team can implement an appropriate strategy to support medication adherence.

The team engages in a collaborative decision-making process to determine a discharge plan and identify when the patient is ready for discharge. If the patient has consented to the TOC service, the ward pharmacist will provide a handover of all key issues and care provided for the patient during hospitalization to the TOC pharmacist. The TOC pharmacist must review prescriptions for clinical, ethical, legal, and Pharmaceutical Benefits Scheme requirements in accordance with relevant guidelines and standards. The TOC pharmacist will reconcile the medications prescribed at discharge. To complete the discharge process, the TOC pharmacist will also complete a discharge medication record (DMR), which is a list that encompasses a written description of instructions for discharge medications, a record of medication changes, and actions or updates for the patient and the primary care provider. Completion of the patient’s discharge also involves reviewing the discharge plan and undertaking any required actions, organizing prescriptions, and ensuring medication supply, if needed.

The TOC team will provide the DMR and other relevant discharge information to the primary care provider (GP and/or community pharmacist) using written and, potentially, verbal communication over the phone.

The TOC team will organize a follow-up consultation with the patient through the platform of their preference (ie, in person, by video, by phone call, or through a home visit) and will confirm a date and time for this consultation within 14 days postdischarge (maximum 30 d). The follow-up consultation will encompass activities described above, such as medication review and optimization, medication education, and lifestyle education tailored to the patient. An updated medication record (same format as the DMR) will be provided to the patient if any changes have been made to their medication regimen since discharge. The TOC team will answer any questions or concerns, resolve any medication issues that arise during the follow-up consultation, and consolidate the medication education provided on discharge, if relevant. The TOC team will refer any issues to the treating team or primary care provider where appropriate. Home visits provide a unique opportunity to review a patient’s medicine stocks and storage practices. While the RECARD TOC team hopes to undertake some home visits where appropriate, this will not be possible for all patients requiring a home visit, especially those who live outside the hospital’s local area. For these patients, the TOC pharmacist will arrange a hospital-initiated Home Medicine Review referral. The Home Medicines Review pharmacist and TOC pharmacist will liaise to ensure the appropriate management of medication-related issues.

The TOC team will aim to provide culturally safe care to all patients, guided by information collected in the yarning circles conducted in phase 1. For patients identifying as Aboriginal and/or Torres Strait Islander, this care will be guided and supported by an Indigenous health worker. The Indigenous health worker will yarn with Aboriginal and Torres Strait Islander patients as needed to help identify the challenges they are experiencing and engage them with the pharmacist, NP, and rehabilitation programs.

Usual care across the hospital sites includes nurse and pharmacist involvement during admission and at discharge (as resources permit), according to standard operating procedures. All patients who are not identified as being at high risk of readmission during the intervention period, along with all patients in the prestudy period (usual care control group), will receive usual care and will not be provided the interdisciplinary pharmacist-led TOC service. Usual care typically does not include dedicated pharmacy support as part of postdischarge follow-up.

The severity and preventability of 30-day medication-related readmission will be assessed as a secondary outcome to assess the types of harm. Methods to assess preventability will include the use of the modified Schumock and Thornton criteria [21]. Methods to assess the severity of medication harm will follow the definitions described by Morimoto et al [22]. A multidisciplinary panel will also review preventability and severity of the medication-related hospital readmissions, as used for causality analysis.

ICD-10-AM “Y” codes to determine “drugs, medicaments and biological substances causing adverse effects in therapeutic use” will be used to identify 60- and 90-day medication-related hospital readmissions.

A patient survey will be developed and administered at the end of the trial to assess patient experience and elicit patient preferences using a discrete choice experiment (DCE). Patient experience will be assessed with a series of multiple-choice, short-answer, and Likert scale questions. Adjustments will be made to the survey after piloting, and the final survey will be uploaded into Qualtrics. The DCE will be conducted to determine the relative importance of each element of the intervention to the patient population and the associated willingness to pay. DCEs use random utility theory to estimate the value of health service provision based on individual attributes of the service [39]. They involve asking the consumers to make discrete choices between mutually exclusive options containing different levels of predefined attributes. The survey will be administered to all patients in the trial where possible.

Cost-effectiveness of the pharmacist-led interdisciplinary TOC service, compared to usual care, for patients post-AMI and/or CS will be determined using data from the primary analysis. A cost-effectiveness analysis will be undertaken to determine the net cost of providing the intervention and any difference in the cost of unplanned 30-day readmissions (primary outcome) compared with the usual care group. Costs will be quantified using data from the trial, the local hospital business unit, and expert opinion. Effectiveness will be measured as the incremental reduction in unplanned 30-day readmissions, and this will be used to determine the incremental cost-effectiveness ratio. All costs will be defined from the perspective of the state health system for a single year (the financial year of the trial) and currency (Australian dollars, AUD). P values less than .05 will be considered statistically significant. The analysis method may be adapted to a cost-minimization analysis or cost-consequence analysis, if required, once the primary outcomes have been analyzed. Sensitivity analysis will be conducted to assess the level of confidence in the conclusions of the economic evaluation. Sensitivity analysis is expected to include variations in resource costs, hospitalization costs, remuneration and savings from the program, and outcome measures, but specific attributes will be identified and their variation limits will be determined after the primary cost-effectiveness analysis has been completed.

The implementation and maintenance secondary outcomes will be evaluated using quarterly interviews with the TOC team to identify site-specific adaptations as well as enablers and barriers to TOC delivery.

It is expected that, under conditions of usual care, the rate of medication-related hospital readmissions within 30 days among patients discharged following an AMI is 7% [40]. Interventions have reduced this rate from 7% to 4.9% (an absolute risk reduction of 2.1%) [41]. As mentioned previously, only a subset of the population (those identified as being at highest-risk based on model scoring and/or clinician referral) will be targeted to receive the intervention. Guided by previous studies and resources, we expect to prioritize the top 25% of patients at high-risk of medication-related readmission [42]. An additional 10% of patients are expected to be referred by the treating team. However, the final proportion of patients who will be triaged for intervention will be guided by a local audit following the development of the risk model. Because the high-risk patients will likely have a higher rate of potential readmission (ie, >7%), we expect that an intervention applied to only this group will still produce an absolute risk reduction of at least 2.1% averaged across the entire intervention sample, even though we expect the risk in the low-risk group to remain unchanged. Therefore, the sample size calculation is based on the overall sample required, not just the high-risk group.

Assuming a baseline risk of readmission of 7% and a significance level of .05, a sample size of 1990 participants is required in both the prestudy and intervention periods (ie, a total of 3980 patients across both prestudy and intervention periods) to detect an absolute risk difference of 2.1% with a power of 0.80. We assume a minimal dropout and refusal rate of 10%; taking this into account, we aim to recruit 2211 participants into each 12-month period (a total of 4422 participants across both the prestudy and intervention periods). We expect 35% of patients (~775 patients) to be flagged as high risk, consent to the study, and be given the TOC intervention. The remainder of the patients enrolled in the study will be given usual care as described earlier. Delivering the TOC service to 775 participants across the study sites over 12 months is both logistically feasible and achievable.

An intention-to-treat analysis will be conducted. Participants who are lost to follow-up (ie, participants who do not complete the intervention, withdraw consent, or die during the study) will be included in the intention-to-treat analysis for the primary outcome. Participant characteristics will be summarized according to the prestudy and poststudy cohorts. Characteristics will be summarized and presented descriptively using mean (SD), median (IQR), and n (%), as required. Independent t tests and chi-square tests will be undertaken to determine whether there are any differences in baseline characteristics between the prestudy and intervention cohorts.

The primary outcome is a comparison of 30-day medication-related hospital readmissions in the prestudy cohort compared with the poststudy cohort. Secondary outcomes will be compared similarly. The analysis will consist of multivariable logistic regression. The explanatory variables will consist of a variable indicating the study period along with any relevant potential confounding variables we wish to control for (eg, patient age, sex, etc). The results for these outcomes will be considered significant at the 5% level, with 95% CIs reported. Subgroup analysis will also be undertaken to assess whether the clinical impact of the intervention varied by location (regional vs metropolitan sites), Indigenous and non-Indigenous patients, and high-risk patients identified according to the model of treating team referral.

Evaluation will be conducted using the RE-AIM framework as described earlier [20]. Data will be analyzed descriptively, and other metrics (eg, primary outcome) will be mapped as calculated above or informed by the patient survey and economic analysis.

Patient data will be collected and collated by the research assistants and postdoctoral research fellows using standardized electronic (REDCap) data collection forms.

Data will be collected from Health Information Management System to identify patients who are readmitted within 30 to 90 days. Re-presentation data for the ED will require data collection from Cerner FirstNet, as ICD-10 codes are not used at the ED sites of the participating hospital. Sociodemographic characteristics, such as age, sex, height, weight, and Aboriginal and/or Torres Strait Islander status; clinical characteristics, such as current medications, medication history, comorbidities, laboratory results (ie, full blood count, renal function tests, liver function tests, coagulation studies, lipid levels, etc), and the Charlson Comorbidity Index; and hospitalization characteristics, such as length of stay, presenting complaint, ward location, cost of admission, and any associated events (readmissions, hospital-acquired complications, or other), and treating team will be compiled using available electronic sources and digital health records. These data will be extracted using hospital reporting systems such as the Hospital Based Corporate Information System and the integrated electronic medical record.

Research staff will use standardized data collection forms to collect the activities that were delivered to patients during the intervention. The same variables will be collected in both the preperiods and postperiods to enable direct comparison of results. Collected data will include sociodemographic, clinical, hospitalization characteristics, and costs associated with the admission of interest and any associated events (readmissions, hospital-acquired complications, or other).

Data will be collected at the sites using standardized electronic (REDCap) data collection forms. REDCap data are encrypted in transit and storage and require 2-factor authentication. REDCap is a secure application that will enable data sharing between Queensland Health (QH) sites. Data will also be stored electronically in a safe and secure manner on a password-protected secure drive on the QH server and/or on the University of Queensland (UQ) Research Data Manager (RDM) server. Deidentified data and statistical analyses can be accessed with appropriate ethics and governance approvals through the UQ RDM system.

The UQ RDM is an access-controlled, authenticated network computer drive managed by Information Technology Services. Trial data will be stored after completion for a minimum of 7 years.

The RECARD program has a Program Steering Committee (PSC) and an Expert Advisory Board (EAB) to which any issues or concerns can be escalated from the research team. In the event of any potential adverse events, these will be managed at each site as per their local care procedures and within QH guidelines. The trial has also been registered, and a review of safety reports will be maintained as a standing agenda item for the PSC meetings so that any questions or concerns can be raised regularly and consistently. To enable optimal safety and harm reporting, there will also be 3 external clinicians who are independent of the RECARD trial team, the PSC, and the EAB, who will act as safety monitors. They will be provided with readmission reports for the intervention period related to cardiac readmissions to each hospital. Trends for readmissions (starting 3 months prior to implementation of the new service model [poststudy]) will be monitored, and any rise potentially attributable to the new model of care will be further investigated at the relevant site.

The Program Management Committee (PMC) will oversee the trial on behalf of the sponsor (the sponsor retains ultimate responsibility for the trial). The PMC is focused on operational matters regarding the trial management. The PMC will provide regular reports to the PSC, such as information on study status, protocol compliance, budget, data management, legal or regulatory issues, and risk management and mitigation.

The PSC will oversee the conduct and integrity of the RECARD trial and will provide support to the PMC. The PSC is responsible for the execution of all activities, including trial design, finalization of the protocol, intervention delivery, data collection, data management, data analysis, report writing, milestone reporting, and results dissemination. An important function is to support risk management and provide status reports to the EAB.

The EAB comprises international experts who will provide oversight and advice to the PSC in relation to the RECARD trial. The UQ School of Pharmacy and Pharmaceutical Sciences is the coordinating faculty on behalf of UQ.

Implementation of an interdisciplinary pharmacist-led cardiology TOC service has the potential to significantly reduce 30-, 60-, and 90-day medication-related hospital readmissions for patients following AMI or CS. It can also lead to reductions in all-cause readmissions at 30, 60, and 90 days, improved patient-reported experiences, and be cost-effective.

Several pharmacist services show clinical and cost-effectiveness, for example, a best possible medication history, reconciliation, and clinical review [43]; discharge education and postdischarge follow-up [1,44]. However, the process of tailoring a series of individualized interventions using a multidisciplinary team in patients with AMI is novel to this study. The benefit of multidisciplinary postdischarge interventions led by pharmacists in other specialties, such as geriatric and general medical patients, has been reported [45]; however, this has not been investigated in high-risk cardiac patients.

Risk prediction models are rapidly evolving, particularly within digitally enabled hospitals, where increasing data availability creates opportunities to improve patient stratification and care delivery. In the context of constrained health care resources, accurately identifying patients who are most likely to benefit from interventions is essential to optimize resource allocation and reduce avoidable harm. Established models, such as the LACE (Length of stay, Acuity of the admission, Charlson Comorbidity Index, and Emergency department visits) index for hospital readmissions [46] and other tools developed for general cardiac populations for all-cause readmission [47], demonstrate the value of prediction approaches in guiding clinical decision-making and targeting high-risk groups.

However, there is currently no dedicated model tailored to patients following AMI or CS, nor is there one that specifically predicts medication-related readmissions in this population. Developing such a model is particularly important given the complexity of post-AMI pharmacotherapy and the associated risk of adverse medication events. Importantly, the predictive performance of risk prediction models is strongest when they are derived from cohorts closely aligned with the intended clinical population, reinforcing the need for AMI-specific tools. As such, implementing a robust, context-specific risk prediction model could enable clinicians to proactively identify high-risk patients and target interventions to prevent medication-related harm after AMI.

A key limitation of this pre-post study design is the potential failure to achieve the intended recruitment target in the postintervention phase, for which there are no clear mitigation strategies. This may reduce statistical power and limit the ability to detect meaningful differences between periods. However, to date, the study is progressing well with recruitment. Additionally, the retrospective-prospective nature of the design involves comparing different patient cohorts across separate time periods, meaning that the groups are not strictly comparable. Temporal changes in patient characteristics and clinical practice may confound the results, making it difficult to attribute observed differences solely to the intervention. This risk can be managed as some confounders can be accounted for or adjusted for in our statistical analysis. A controlled cohort design could have improved comparability and reduced bias; however, such an approach was not feasible in this context. Specifically, withholding a gold-standard medication management service from high-risk patients—who are most likely to benefit—would raise ethical concerns, necessitating the use of a less rigorous but more ethically appropriate pre-post design.

The study is among the first to determine whether a pharmacist-led Cardiology TOC service reduces 30-day medication-related patient readmissions and secondary outcomes. The findings will inform future implementation of a sustainable cardiac TOC model within the Australian health care setting.

The recent publication of the Medication Management at Transitions of Care Stewardship Framework by the Australian Commission [48] emphasizes that TOC, especially from the hospital to the home, is a high-risk period for medication errors, miscommunication, and preventable harm and therefore requires a structured stewardship approach to improve safety and outcomes. It outlines 4 core elements: strong governance through a designated committee, a multidisciplinary stewardship team to lead and champion improvements, coordinated medication management activities from admission to postdischarge, and continuous monitoring, evaluation, and feedback. The framework highlights person-centered care, effective communication, and digitally enabled information sharing as essential enablers, stressing early risk assessment, clear roles between providers, medication reconciliation at every transition, and robust, timely discharge communication [48].

The RECARD study follows these guidelines to provide a systematic, scalable model for health services to strengthen medication safety, reduce medication-harm-related readmissions, and ensure safer, more seamless care across the entire patient journey.