Transcript the Pharmacy Education for Demonstration Project

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.
Assessing Health Care Quality
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:
Patient
Provider
Payer
• safe
• effective
• patient-centered
• timely
• efficient
• equitable
Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.
Changing to a High Quality Health Care System
Many different organizations are changing the quality of the Health Care System:
Guideline
Development
Evidence-based Medicine:
Guideline Developers:
• Associations
• AHA/ACC
• AMA
• (Many others!)
• ADA
• AHA
Measure
Development
•
•
•
•
•
NCQA
JCAHO
AHRQ
Health Plans
Prof. Associations
• AHA/ACC
• Others (PQA)
Measure
Endorsement
National Quality Forum (NQF)
Consensus Development
Process
Measure Selection for Public
Reporting, Pay for Reporting
Pay for Performance
• CMS, AHRQ
• Alliances
(HQA, AQA, PQA)
• The LeapFrog Group
• Bridges to Excellence
• Other collaborative
P4P/P4R
Pharmacy Performance Measures
Today
•
•
•
•
•
•
•
Future
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
• Patient Compliance rates
• Optimal asthma therapy
• Optimal diabetes care
management
• Appropriate medications for the
elderly
• Patient satisfaction-clinical care
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.
Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.
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.
*Center for Medicare and Medicaid Services
**America’s Health Insurance Plans
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
How is the data obtained for the
performance measure reports
Pharmacy
Store
Store Report
Cards
Pharmacy
Store
Store Report
Cards
Payer Data
regarding
Rx Claims
Regenstrief
Institute
Data Analysis
Pharmacy
Store
Store Report
Cards
Pharmacy
Store
Store Report
Cards
Performance Report Website:
http://www.IndianaPharmacyCompare.org
If you have
questions or
comments
Measurement
Period
Pull-down to see
your store
characteristics
(demographics)
Survey to
report your
opinions of the
website
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
Your store performance (number
of patient meeting
criteria/potential patients
eligible)
Pull-down to see
definitions
Denotes an improvement
opportunity or individual
store percentage does not
meet the average
Individual store
ranking based on
participating
pharmacies
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, RPh
Purdue University
(765) 494-5966
[email protected]
Carol Birk, MS, RPh
PharmaTAP
(317) 698-9026
[email protected]