Monitoring and Reporting Quality Performance and Medication Safety in Community Pharmacy.
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Transcript of Monitoring and Reporting Quality Performance and Medication Safety in Community Pharmacy.
Overview
• This educational material is to assist you in viewing and interpreting your pharmacy performance reports as part of the Purdue University demonstration project.
• After reading this material, proceed to your individual store pharmacy quality measures (Your Pharmacy Quality Measures link). View your results and let the investigators know if you have any questions using the “Contact Us” link.
• When you have viewed your individual store report, complete the feedback survey to let the investigators know your thoughts on the website.
• safe• effective• patient-centered• timely• efficient• equitable
Patient
Provider Payer
Concerns about quality are different based on the stakeholders. Stakeholders may have different, as well as overlapping priorities in regards to quality. However, a high quality system must be:
Assessing Health Care Quality
Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.
National Quality Forum (NQF)
Consensus Development Process
MeasureDevelopment
Measure Endorsement
Guideline Development
Many different organizations are changing the quality of the Health Care System:
Changing to a High Quality Health Care System
Evidence-based Medicine: Guideline Developers: • Associations• AHA/ACC• AMA• (Many others!)• ADA• AHA
Measure Selection for Public Reporting, Pay for Reporting
Pay for Performance
• NCQA• JCAHO• AHRQ• Health Plans• Prof. Associations• AHA/ACC
• Others (PQA)• CMS, AHRQ• Alliances
(HQA, AQA, PQA)• The LeapFrog Group• Bridges to Excellence• Other collaborative
P4P/P4R
• Patient Compliance rates• Optimal asthma therapy• Optimal diabetes care
management• Appropriate medications for the
elderly• Patient satisfaction-clinical care
oriented
Today• Number of prescriptions filled/day• Generic conversion• Prescriptions filled per unit of time• Labor Cost per prescription• Rx sales• New/Refill prescription ratio• Patient Satisfaction – convenience
oriented
Expanding Measurement to focus on “Quality of Pharmacy Services” will help to promote the pharmacist as a key patient care provider
who assures appropriate medication use.
Expanding Measurement to focus on “Quality of Pharmacy Services” will help to promote the pharmacist as a key patient care provider
who assures appropriate medication use.
Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.
Pharmacy Performance Measures
Future
*Center for Medicare and Medicaid Services **America’s Health Insurance Plans
Pharmacy Quality Alliance (PQA)
• Includes over 60 member organizations in the U.S.
• Started by a collaborative of the federal government (CMS*) and private organizations (ie. AHIP**) a with the goal to develop and report quality/efficiency measures of pharmacy/pharmacists services.
• Is a membership-based, self-sustaining, consensus-driven, organization.
• Funded 5 demonstration projects to determine the feasibility of using a starter set of expanded quality performance measures of pharmacy services.
Demonstration Project
• Purdue University received funding from PQA for a demonstration project focused on central Indiana community pharmacies.
• Project consists of:– PQA Developed and Endorsed Quality Performance Measures.– Retrospective analysis of prescription claims data.– Patient experience (satisfaction) survey.– Web-based performance reports.
• For this project:– All quality reports are password protected and confidential.– Authorized pharmacists only can view their own pharmacy reports.– Reports do NOT affect individual or store performance evaluations.
PQA Endorsed Performance Measures
• Proportion of Days Covered (PDC)– Percent of patients who met threshold of 80 percent or have medication available
to them for 80% of the days covered by the prescription– Reported for: Beta Blockers , ACEI/ARB, Calcium Channel Blockers, Dyslipidemia
Medications, Diabetes Mediations (Sulfonylureas, Biguanides, TZDs)
• Gap in Therapy– Percent of patients who were dispensed at least 2 prescriptions in a specific
therapeutic category who experienced a gap in medication therapy of greater than or equal to 30 days
– Reported for: Beta Blockers , ACEI/ARB, Calcium Channel Blockers, Dyslipidemia Medications, Diabetes Mediations (Sulfonylureas, Biguanides, TZDs)
• Diabetes: Excessive Doses of Oral Medications– Percent of patients who were dispensed a dose higher than the daily
recommended dose for biguanides, sulfonlyureas, and thiazolidinediones
PQA Endorsed Performance Measures Cont.
• Diabetes: Suboptimal Treatment of Hypertension– Percent of patients who were dispensed a medication for diabetes and
hypertension who are not receiving an ACEI or ARB medication
• Asthma: Suboptimal Control– Percent of patients with persistent asthma who were dispensed more than 5
canisters of a short acting beta2 agonist inhaler during the same 3 month period
• Asthma: Absence of Controller Therapy– Percent of patients with persistent asthma who were dispensed more than 5
canisters of short acting beta2 agonist inhalers over a 90 day period who did not receive controller therapy during the same 90-day period
Pharmacy Store
Pharmacy Store
Pharmacy Store
Pharmacy Store
Payer Data regardingRx Claims
Regenstrief Institute Data Analysis
Rx Cl
aims
Rx Claims
How is the data obtained for the performance measure reports
Store ReportCards
Store ReportCards
Store ReportCards
Store ReportCards
Measurement Period
Measurement Period
Survey to report your
opinions of the website
Survey to report your
opinions of the website
Pull-down to see your store
characteristics (demographics)
Pull-down to see your store
characteristics (demographics)
If you have questions or comments
If you have questions or comments
Estimate of the percent of patients qualifying for the
measure that only used your store for prescriptions of this
medication type
Estimate of the percent of patients qualifying for the
measure that only used your store for prescriptions of this
medication type
Performance Report Website: http://www.IndianaPharmacyCompare.org
Describes the desired outcome
Describes the desired outcome
Denotes an improvement opportunity or individual
store percentage does not meet the average
Denotes an improvement opportunity or individual
store percentage does not meet the average
Pull-down to see definitions
Pull-down to see definitions
Your store performance (number of patient meeting
criteria/potential patients eligible)
Your store performance (number of patient meeting
criteria/potential patients eligible)
Individual store ranking based on
participating pharmacies
Individual store ranking based on
participating pharmacies
Performance Report Website:http://www.IndianaPharmacyCompare.org
I have seen the performance measures. Now what?
• What are ways to improve compliance?– Identify patients with late refills and discuss any concerns– Develop “registries” of patients that are late to refill– Telephone, mail, email, text contacts for reminders
• What are ways to improve therapy?– Offer services such as “brown bag” discussions– Use your employer’s innovative programs– Pay attention to alerts and act on them
• Simplify drug regimens– Change medication dosing to “once daily” if possibleAct on therapy duplicates– Contact physicians when patient therapy could be maximized
I have seen the performance measures and I have questions
Kimberly S. Plake, PhD, RPhPurdue University(765) [email protected]
Carol Birk, MS, RPhPharmaTAP(317) [email protected]