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Pharmacy
Quality Data
MEASURES, MEASURING AND ME
Michael Crooks, PharmD
Pharmacy Interventions Technical Lead
Alliant Quality – Georgia’s Medicare Quality
Improvement Organization
Learning Objectives
-Recall Medication-related quality measures beyond
the Medicare Star Ratings
-Recognize opportunities for pharmacists to improve
medication-related quality measures for health care
providers and organizations
-Apply basic skills in the Model for Improvement for
data collection, evaluation and change measurement to
pharmacy practice
Disclosure
I do not have (nor does any immediate family member
have) actual or potential conflict of interest, within the
last twelve months; a vested interest in or affiliation
with any corporate organization offering financial
support or grant monies for this continuing education
activity; or any affiliation with an organization whose
philosophy could potentially bias my presentation.
Source: CMS Physician Quality Reporting Strategic Vision – Final Draft 2015
Health Care Quality Defined
Institute of Medicine: “safe, effective,
patient-centered, timely, efficient and
equitable.”
Agency for Healthcare Research and Quality:
“as doing the right thing for the right patient,
at the right time, in the right way to achieve
the best possible results.”
Source: NCQA (National Committee for Quality Assurance) Essential Guide to
Health Care Quality. 2007
CMS Physician Quality
Reporting Strategic Vision
PAY FOR
PERFORMANCE
BETTER
QUALITY
Source: CMS Physician Quality Reporting Strategic Vision – Final Draft 2015
Health Care Quality
Measurement
Systematic: standardized
Rigorous: reliable, validated, evidencebased and supported by expert consensus
Quantifiable: compare results against a
reference, standard or benchmark
Source: NCQA (National Committee for Quality Assurance) Essential Guide to
Health Care Quality. 2007
Health Care Quality Measures
Process: Was something done? Lab test, timely
referral, RX prescribed
Outcomes: Did the patient benefit? Resolution
of symptom, avoided complication
Experience: Is the patient/caregiver satisfied?
Surveys, discharge questionnaires
Source: NCQA (National Committee for Quality Assurance) Essential Guide to
Health Care Quality. 2007
Medication-Related Quality
Measures
Medicare Part D Star Ratings and Pharmacy
Quality Alliance
Measures Adopted from Quality Standards
Organizations
Internal Quality Measurement
Learn more at
PQAalliance.org
5 Measures of
appropriate
medication use.
Almost half of
Rating Score
(13 out of 30.5)
Source:”PQA Measures Used By CMS in the Star Ratings” Pharmacy Quality Alliance.
http://pqaalliance.org/measures/cms.asp. Web March 25, 2016
5 other
measures that
pharmacists can
impact.
Another 36% of
Ratings Score
(11 out of 30.5)
Total is 79%
Source:”PQA Measures Used By CMS in the Star Ratings” Pharmacy Quality Alliance.
http://pqaalliance.org/measures/cms.asp. Web March 25, 2016
Other PQA Measures – Medicare
Advantage Plan Quality Measures:
Annual Influenza vaccination
Glucose and cholesterol control in diabetes
patients
Blood pressure control
Osteoporosis management in women who have
had fractures
Rheumatoid arthritis management
Cholesterol screening
Source: ”Pharmacists’ Stellar Experience Can Create Five-Star Success”
The Consultant Pharmacist.. Vol 29, No 12. pp788-796. Dec 2014
Other PQA Measures – Display
Measures
Use of Benzodiazepine Sedative Hypnotic Medications
in the Elderly
◦ % of 65+ year olds that received 2+ prescription fills for any
benzodiazepine sedative hypnotic for 90+ cumulative days
Use of Opioids at High Dosage in Persons Without
Cancer
◦ The proportion of non-cancer, adult patients receiving a daily
dosage of opioids greater than 120mg morphine equivalent
dose (MED) for 90 consecutive days or longer.
Source:”PQA Measures Used By CMS in the Star Ratings” Pharmacy Quality Alliance.
http://pqaalliance.org/measures/cms.asp. Web March 25, 2016
Defining the Population of Focus
All Pharmacy
Patients
Patient Criteria 1
Patient Criteria 2
Population of Focus
Denominator
Condition
Outcome Measure
Denominator
Numerator
condition
Outcome Measure
Numerator
Defining the Population of Focus
Example: High-Dose
Opioid use in noncancer patients
Population of Focus
Have 2+ meds, filled
over ≥150 days; no
oncology meds
Outcome Measure
Denominator
Outcome Measure
Numerator
Quality Standards
Organizations and Measures
HEDIS: Health Effectiveness Data and Information
Set
◦ Health plan quality measures derived from insurance claims,
applicable to Commercial, Medicaid and Medicare plans
VBM: Value-Based Modifier
◦ Payment adjustment for physicians based on performance
measures in the Physician Quality Reporting System (PQRS)
HRRP: Hospital Readmission Reduction Program
◦ Payment reduction (penalty) to hospitals for ‘excessive’
readmission rates
Pharmacy Quality Improvement
Opportunities: HEDIS
Annual monitoring for patients using ACE-I/ARB
◦ % of patients using ACE-I/ARB for ≥180 days who have lab
measures for K+ and CrCl within the year
Flu vaccinations for adults 18-64
◦ % of patients in the age range responding “yes” to the
survey question “Have you had a flu shot since July 1 of
2015?”
Medication Management for patients with Asthma
◦ % of patients 5 to 64 with persistent asthma with ≥75%
proportion of days covered with asthma controller
medications
Source: “Quality Rating System, Measure Technical Specifications” CMS.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/QualityInitiativesGenInfo/Downloads/2016-QRS-Measure-TechnicalSpecifications.pdf. Web March 25, 2016
Defining the Population of Focus
All Pharmacy
Patients
Patients 18 and
over
Example: Lab
monitoring for
Persistent
ACE-I/ARB Use
Patients Using
ACE-I/ARB
for≥180 days
Population of Focus
18+ w/claim
for ACE-I/ARB
for≥180 days
Outcome Measure
Denominator
Completed
Labs for K+
and CrCl
Outcome Measure
Numerator
Pharmacy Quality Improvement
Opportunities: VBM and PQRS
PQRS #001: Medication Reconciliation
◦ % of patients ≥18 years discharged from inpatient facility who
are seen within 30 days with documented medication
reconciliation of discharge medication orders and current
medication list
PQRS #111: Pneumococcal Vaccination Status for Older
Adults
◦ % of patients 65 years who have ever received a
pneumococcal vaccination
Source: “2015 Cross-Cutting Measures List ” CMS.
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Downloads/2015_PQRS_CrosscuttingMeasures
_12172014.pdf. Web March 25, 2016
Defining the Population of Focus
All Pharmacy
Patients
Medicare patient
18 and over
Discharged from
inpatient facility
Patients referred
to your care transitions program
Seen w/in 30
days and Med
Rec
Documented
Example: PQRS Medication
Reconciliation
Population of Focus
Outcome Measure
Denominator
Outcome Measure
Numerator
Pharmacy Quality Improvement
Opportunities: Internal Quality
Measurement
Self-measurement of validated measures
Other outcomes, process or experience
measures
Pharmacy workflow measures
Pharmacy business/financial measures
Activity: Designing a Pharmacy
Quality Improvement Measure
Work in groups to decide on a quality improvement
measure and complete a Population of Focus
worksheet
3 minutes to complete
Report out from your group:
What are you trying to accomplish
How will you know a change is an improvement
What change can you make that will result in improvement
Activity: Designing a Pharmacy
Quality Improvement Measure
Work in groups to decide on a quality improvement
measure and complete a Population of Focus
worksheet
3 minutes to complete
Consider a measure important to you:
Business:
% Children’s liquid meds upsold w/flavoring
% days on hand >35 days for Rx stock valued $500
Patient Care: % patients with diabetes on ACE-I/ARB
% opioid patients with control Rx from 4+ MDs
Workflow: % filled Rx returned to stock
Defining the Population of Focus
All Pharmacy
Patients
Patient Criteria 1
Patient Criteria
2
Population of Focus
Denominator
Condition
Outcome Measure
Denominator
Numerator
condition
Outcome Measure
Numerator
Model For Improvement
Activity: Designing a Pharmacy
Quality Improvement Plan
Now that you’ve decided on a measure, consider:
What factors have a negative influence on the rate?
Which is most significant and what are the root causes?
What can you do to change this root cause?
Report out from your group:
What are you trying to accomplish?
What change can you make that will result in improvement?
How will you know a change is an improvement – what data
can you measure?
PDSA Cycle for Process
Improvement
ACT
 What changes are to be
made?
 Next cycle – continue,
adapt or discontinue?
STUDY
 Complete the analysis of the
data
 Compare data to predictions
 Summarize what is learned
PLAN
Start
 Objective
 Questions and predictions
 Plan to carry out the cycle
(who, what, where, when)
 Plan for data collection
DO
 Carry out the plan
 Document the problems and
unexpected observations
 Begin analysis of the data
Root Cause Analysis Template
Project Flow
Define
population
and measures
Develop AIM
P
A
D
A
S
Obtain
baseline
measures
P
P
D
S
A
D
S
Set
measureable
goals
Re-measure
Re-measure
MIchael Crooks, PharmD.
Alliant Quality – Medicare QIO for Georgia
[email protected]
678-527-3601
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