Pharmacy Quality Alliance Environmental Scan

1
Pharmacy Quality Alliance Environmental Scan

• Brad Tice, PharmD, PMP
• Associate Professor
• Drake University College of Pharmacy Health
  Sciences

2
Purpose

• To conduct an environmental scan within
  healthcare to identify, review and delineate
  where metrics exist that correlate to and
  correspond with the PQAs template for a starter
  set of metrics.
• Goal
• All-Inclusive
• Transparent
• Focus on Starter Set

3
PQAs Initial Starter Set of Metrics

• Short-Term Measures
• Patient Care/MTM Services
• Diabetes
• Hyperlipidemia
• Respiratory Disorders
• Hypertension
• Heart Failure
• Patient Safety Goal
• Reduce the use of drugs that have been shown to
  be contraindicated in the elderly or more likely
  to result in adverse events or drug interactions.
  
• Patient Education
• Generic Efficiency Index and Formulary Management
  Goals
• Assuring quality of care through cost-effective
  drug therapy

4
PQAs Initial Starter Set of Metrics

• Medium-Term Measures
• Prevention and Wellness Programs
• Smoking Cessation
• Vaccination

5
Methods

• Sources Identified
• Internet Search
• Input from PQA members
• General awareness
• 13 sources
• includes National Quality Measures Clearinghouse
  which includes over 35 contributors

6
Criteria

• Criteria to Evaluate Established
• Porter Michael E., Teisberg Elizabeth O.,
  Redefining Health Care Creating Value-Based
  Competition on Results, Harvard Business School
  Press, Boston, Massachussetts, 2006.
• Committee on Redesigning Health Insurance
  Performance Measures, Payment, and Performance
  Improvement Programs, Board on Health Care
  Services, Performance Measurement Accelerating
  Improvement, Institute of Medicine of the
  National Academies, National Academies Press,
  2006.
• Kaplan Robert S., Norton David P., The Balanced
  Scorecard Translating Strategy into Action,
  Harvard Business School Press, Boston,
  Massachussetts, 1996.

7
Background

• Focus on Value for Patients
• Competition Based on Results
• Competition at the Medical Condition Level
• Competition Over the Full Cycle of Care
• Innovations that Increase Value Should be
  Strongly Rewarded

8
Database Categories

• ID
• Measure
• Definition
• Creator
• Data Source
• Pharmacy Relevance
• Donabedian

• Type
• FACCT Domains
• IOM Priority Areas
• Pharmacy Setting
• General Disease Category
• IOM Six Aims (primary, secondary, tertiary)

9
Results

• 1,676 Measures Identified
• Short-Term Measures
• Diabetes 97 general Measures
• MPR 0/11
• ACE/ARB 9 Measures
• Statin 1/16
• Influenza vaccine 2/21
• Hyperlipidemia - MPR - 0/17
• Respiratory
• MPR 0/17
• Adequacy of therapy - 12

10
Results

• Hypertension 44 general
• MPR 0/7 starting therapy
• Heart Failure 150 general
• MPR 0/50
• Adequacy of Therapy
• Beta Blocker 8/23
• ACE/ARB 20

11
Results

• Patient Safety 123/272/63
• 77 pharmacy relevant
• Elderly-specific 18
• Patient Education 45
• Generics 0
• Medium-Term Measures
• Smoking Cessation 28
• Vaccinations - 28

12
Gap Analysis

• IOM Report Performance Measurement Accelerating
  Quality
• Narrow time window
• Provider-centric focus
• Narrow focus of accountability
• Composite measures

13
Gap Analysis

• Identified Areas Lacking Measures
• Pharmacist Interventions
• Adverse Drug Events Identification and
  Resolution
• Adherence/Persistence
• Health Literacy
• Patient Safety
• Pharmacist-specific measures

14
Gap Analysis

• Areas with measures currently not included in
  starter set
• Arthritis
• HIV
• Infectious Disease
• Ischemic Heart Disease
• Mental Illness

• Patient Centered
• Patient Satisfaction
• Customer Satisfaction
• Pain Management

15
Limitations

• E-scan performed by one individual
• Single pass categorization
• Not all measures distinct
• Could have used an additional categorization for
  drug-specific measures to include additional
  category for drug.

16
Appendices

• Evidence of Value of Pharmacists
• Literature search quality, measures, pharmacy
• Literature search adherence, persistence,
  medications
• IOM Report measure criteria
• IOM Report recommended starter set
• AMCP/NCQA White Paper Upcoming Book Chapter
• To be added Inappropriate Medication List
  Beers, Zhan, others?