Nau Appointed Senior Director of Research and Performance Measurement for PQA

Pharmacy Quality Alliance, Inc (PQA) has named David Nau, RPh, PhD, CPHQ to the newly established position of Senior Director of Research and Performance Measurement. In his new role, Nau will be responsible for all research and grant-related activities at PQA and also provide oversight of the ongoing demonstration projects.

Dr. Nau comes to PQA with an extensive background in academia and the healthcare field. Prior to joining PQA, he held tenured faculty appointments at the Universities of Michigan and Kentucky. In his most recent position, Nau served as Manager of Research Strategies for Humana Pharmacy Solutions.

“David is uniquely qualified for this new position and will be a major asset to the organization as PQA continues to move its objectives forward in terms of developing and encouraging the adoption of meaningful medication use measures that can be used to deliver high-value healthcare and pharmacy services”, stated Laura Cranston, Executive Director for PQA, “and we are most pleased to have him on the PQA team.”

Dr. Nau received his B.S. in Pharmacy from Ohio Northern University, an M.S. in Pharmacy Administration from the University of Toledo and his Ph.D. from the University of Florida in 1997. He also holds the designation of Certified Professional in Healthcare Quality (CPHQ).

PQA develops medication use measure concepts in key areas of interest to a broad array of stakeholders including: medication therapy management, prevention and wellness, patient safety, medication reconciliation as well as a continued focus on medication adherence.
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Save the Date! February 4, 2010 at 1pm EST PQA Lecture Series will Examine Use of Registries in Advancing Quality

The February PQA Quality Forum Lecture Series will feature Bruce Bagley, MD discussing “The Role of Registries as a Systematic Quality Improvement Tool.” Dr. Bagley has been a leader in bringing quality improvement into medical practice and a strong advocate for the patient-centered medical home. For this presentation he will focus on the value of registries in improving the efficiency of care and quality outcomes, particularly in managing patients with chronic illnesses.

Bruce Bagley, MD, is the Medical Director for Quality Improvement for the American Academy of Family Physicians (AAFP). The AAFP represents more than 94,000 family physicians, family practice residents and medical students nationwide. His current responsibilities with the AAFP include liaison work with other national organizations in the quality arena and active participation in the development, deployment and implementation of performance measures as well as providing clinical oversight for quality improvement programs and products developed by the AAFP. Dr. Bagley has spoken extensively on the topics of performance measurement, office redesign, electronic health records and leadership. He is a 2005-6 Malcolm Baldrige Quality Award examiner.

This one-hour teleconference lecture on will take place on Thursday, February 4th at 1pm EST. As space is limited for this presentation, please RSVP by Monday, January 29th, 2010 to PQA’s Administrator, Karen Peterson at kpeterson@PQAalliance.org. The dial in number and materials for the call will be provided to registrants on February 2nd.
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Building Quality: A Recurring Status Report on the PQA Demonstration Projects

As described in the November issue of Quality Connection, the Phase I demonstration projects have concluded their work and are wrapping up their final evaluations. The AHRQ-funded evaluators, CNA and Thomas Jefferson University, have been interviewing the key staff for each project and are also conducting a survey of the participating pharmacists. They will issue their report to AHRQ in the first quarter of 2010 and will also develop a manuscript for a peer-reviewed journal that targets health policy makers. The project directors from each of the demonstration sites are also collaborating on a manuscript that will be directed towards pharmacists. Some of the sites will also be giving presentations at the American Pharmacists Association annual meeting in March.

Phase II collaborative teams are working with Dr. David Nau, Senior Director of Research & Performance Measurement for PQA, to refine their proposals and seek external funding. The overarching goal of the Phase II demonstrations is to assess how pharmacists and drug plans can work collaboratively to improve medication adherence and safety, and to track this improvement with the PQA-endorsed measures. PQA is currently working with the following 4 collaborative teams to get their projects funded and initiated by mid-2010.  

• Highmark/ Rite-Aid/ CECity/ U of Pittsburgh
• Pharmacy Society of WI/ U of WI/WI Medicaid
• PharmMD Solutions/ HealthSpring/ Emdeon
• U of IL-Chicago/ Humana/ SUPERVALU Inc.

PQA is facilitating the funding process through private and public sources. The extent of project development will be based on the degree of external funding support received. To date, an AHRQ proposal has been submitted by the Pennsylvania collaborative that involves Highmark, RiteAid, CECITY and the University of Pittsburgh. At least 2 more AHRQ proposals will be submitted by the collaboratives in Wisconsin and Illinois. PQA has also had very positive discussions with several private foundations and pharmaceutical companies, and it is anticipated that several demonstration sites will be able to start their work by mid-2010.
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PQA / HQA / AQA … Seeking Common Ground

On December 8, 2009, the principals and senior staff of the PQA, the Hospital Quality Alliance (HQA), and the Ambulatory Quality Alliance, more commonly referred to as AQA, convened via conference call to initiate a discussion on their respective goals and to begin looking for common ground for collaboration. PQA was represented by Laura Cranston, David Nau, and Board members Eleanor Perfetto, Woody Eisenberg and Bruce Sherman. The HQA has been focused on identification and maintenance of performance measures for hospitals (with some of those measures appearing on the CMS-supported website called Hospital Compare) as well as pay-for-performance initiatives. The AQA has recently shifted its focus away from endorsement of performance measures towards implementation of measures and demonstration projects on public reporting and pay-for-performance. The staff of the 3 alliances will meet again in January to further define their common interests. A potential area for collaboration is “transitions in care” with a particular emphasis on better coordination of patients’ transition from hospital to home. David Nau will serve as staff liaison to this multi-alliance discussion and will update the PQA membership on any collaboration developments.
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Hot Off the Press: Rapid Reviews of Key Quality Publications and Studies

In this, and subsequent issues of Quality Connection, we will provide citations for recent articles that are highly relevant to the improvement of medication-use quality. In this issue, our focus is on the work of Barry Carter and his colleagues at the University of Iowa. Their article in the Archives of Internal Medicine describes a prospective, cluster randomized, clinical trial to assess the impact of pharmacist-physician collaboration to improve blood pressure control.

All of the study patients had poor blood pressure (BP) control at baseline. After six months, 29.9% of control group patients versus 63.9% of the intervention group patients had achieved acceptable BP. After statistical adjustment for baseline differences in the groups, the intervention group patients were approximately 3 times more likely to achieve BP control when compared to the control group. Adherence to clinical guidelines was also much higher in the intervention group than the controls.

Why This Study is Relevant

This study reinforces the need for team-based care and the inclusion of pharmacists in the care team. As our healthcare system embraces the “medical home” model, it is important to consider a role for pharmacists in the medical home. The Carter study focused on care in family medicine residency sites. They found that creating a pharmacist-physician team increased the likelihood of patients achieving good BP control. One would assume that care outside of medical residency sites would benefit even more from a pharmacist-physician team providing medication therapy management. What is still unknown is whether physicians outside of residency programs are as likely to accept the recommendations of pharmacists and how a community pharmacist can fit within the medical home model.

The PQA Phase II demonstration projects will examine how community pharmacists can play a role in driving improvements in patients’ use of medications and some of these projects will offer insights on how pharmacists could interface with physicians in a typical community setting to support a team-based medical home model.

Highlighted Article:  Carter BL, Ardery G, Dawson JD, et al. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med. 2009;169:1996-2002.

Additional Articles Worth Reading

Kleiner SA, Vogt WB, Gladowski P, et al. β-blocker compliance, mortality and reinfarction: Validation of clinical trials association using insurer claims data. Am J Med Qual. 2009;24:512-19.

Sanderson BK, Thompson J, Brown TM, Tucker MJ, Bittner V. Assessing patient recall of discharge instructions for acute myocardial infarction. J Healthcare Qual. 2009;31:25-34.

Winston S, Lin YS. Impact on drug cost and use of Medicare Part D of medication therapy management services delivered in 2007. J Am Pharm Assoc. 2009;49:813-20. 
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Webb, Domann Provide Insights into Current Evolution of the Patient-Centered Medical Home

The December offering of the PQA Quality Forum Lecture Series featured a well attended teleconference presentation, The Intersection of the Medical Home, Medication Management and Quality Improvement, presented by Ed Webb and Dave Domann, Co-Chairs for the PQA cluster group “The Pharmacist’s Role in the Patient-Centered Medical Home.” Ed Webb, PharmD, MPH, serves as the Associate Executive Director and Director of Government and Professional Affairs for the American College of Clinical Pharmacy and Dave Domann, MS, RPh is the Director of Future Market Strategies for Ortho-McNeil Janssen Pharmaceuticals.

Dave Domann discussed key performance standards including managing existing conditions, coordinating care, utilizing systems at the level of care to achieve health outcomes and focusing on the “whole person”. He also discussed the likely shift in the payment model from a fee-for-service model to a new “blended hybrid” that will be incentivized by reimbursement tied not just to office visits, but to care coordination and performance (including clinical and quality outcomes).

Dr. Webb outlined the key elements for Comprehensive Medication Management necessary to assure delivery of value:

Some examples of PCMH models were provided, such as the Community Care of North Carolina effort. This pilot demonstrated decreased hospital and ED use with increased medication adherence in asthmatics, and improvements in quality measures in patients with diabetes. These outcomes were attributed to clinical pharmacists working with the health care team.

Both Dr. Webb and Mr. Domann commented that PQA is a vital and well-aligned stakeholder in the development of the patient-centered medical home. Laura Cranston, Executive Director of PQA, added her voice of support for the work of the cluster on the medical home, noting that it reflects “the PQA mission to improve the quality of medication use across healthcare settings through a collaborative process in which key stakeholders agree on a strategy for measuring and reporting performance information related to medications”. 

For additional information on this topic go to http://www.pcpcc.net. To view slides from this presentation visit www.pqaalliance.org.
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New Alliance Launched to Improve the Quality of Life For Consumers of Long Term Services and Supports

Long-Term Quality Alliance Will Focus on Measuring and Improving Care Across Settings
To Achieve More Effective and Efficient Long-Term Care Experiences

“The way we currently measure the quality of long-term care in this country focuses too much on clinical services delivered in nursing homes. The perspectives of consumers and their family caregivers have largely been ignored,” says Alliance Chair Mary Naylor, PhD, RN, Marion S. Ware Professor in Gerontology at the University of Pennsylvania’s School of Nursing. “In this rapidly changing long-term care environment, we need to advance a set of measures that reflect what is important to consumers and apply those across all settings. Providers also need access to best practices that will improve the quality of their services,” says Naylor, who announced the new Alliance on January 5th, 2010 at a Washington, D.C., briefing on long-term care sponsored by the policy journal, Health Affairs.

The LTQA Board is comprised of 29 leaders from organizations representing caregivers, consumers, quality improvement, nursing homes, accreditation, aging issues, foundations, the federal government, private payers, and academia. The group was formed to respond to the increasing demand for long-term care and the expanding field of providers who are delivering that care, including in-home and community-based settings such as assisted living facilities and adult day care. “Although long-term services and supports have a major impact on health, health costs, and quality of life for millions of frail and chronically ill people, efforts to improve the quality and value of this sector, especially outside of the institutional setting, have been absent from the national health care debate,” says Naylor. “We have seen great progress on improving nursing home care but such advances have not been matched across the broad spectrum of long-term care,” she adds.

The Alliance will focus initially on two important health care issues that have been identified as national health priorities – how to improve care coordination or transitions in care and how to avoid unnecessary hospital admissions among frail and chronically ill people. Naylor says that these two areas offer the greatest promise for improving quality, consumer experiences, and efficiency, as well as reducing costs.

The group will hold its first formal meeting on January 28, 2010 at the Brookings Institution and will operate as a membership organization.
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CMS Weaves Quality and Performance Measurement into Medicare Part D Plan Structure

PQA kicked off the 2010 Quality Forum Lecture Series on January 7, 2010 with a presentation by Michelle Ketcham, PharmD, MBA entitled The Role of Quality Initiatives and Performance Measurement within Medicare Part D. Dr. Ketcham serves as the data analysis lead for CMS Division of Clinical and Operational Performance (DCOP) in the Medicare Drug Benefit and C&D Group within the Center for Drug and Health Plan Choice (CPC). Dr. Ketcham is also an active member of the PQA Quality Metrics and PQA Communications and Education workgroups.

The Part D plan ratings allow beneficiaries to compare plans based on quality, performance and cost via the MPDPF to make informed enrollment decisions (www.Medicare.gov).  Four levels of ratings are provided, including an overall summary score for quick evaluation as well as individual measure values. A 5-star rating scale is used ranging from poor to excellent performance.  The plan ratings include 19 distinct measures classified into 4 domains comprised of drug plan customer service, plan member complaints, members who choose to leave and audit findings, member satisfaction and lastly, drug pricing and patient safety.

Dr. Ketcham emphasized the significance of the 2 measures in the patient safety domain, which include members’ utilization of drugs with high risk of side effects and diabetes optimal treatment. She noted that “both of these patient safety measures are derived from the initial PQA measure ‘starter set’ and reflect the value of the PQA efforts in both development and uptake into actual practice.” The quality and performance information can be viewed by going to the www.Medicare.gov website and using the “Compare Medicare Prescription Drug Plan” search tools. When a beneficiary performs a search to find the plans available in their area, the Plan Ratings can be found by selecting “View quality and performance ratings for all available plans”.

Dr. Ketcham explained that the Part D display measures provide additional information about the sponsors’ performance via the section of the CMS website on the Part D Performance. This includes measures in development, duplicative or limited by sample size and therefore not ready for display in the plan ratings content, but still valuable for public sharing. Notably, two of the measures in this section include drug-drug interactions and diabetes medication dosing, which are also measures tied to PQA efforts.

CMS also offers, through contractor, Acumen, LLC, the Patient Safety and Analysis website and reports, which allow Part D sponsors to compare performance with other plans and monitor their progress in improving the measures. Dr. Ketcham shared that “plans can now view and download a number of Part D measure-related reports including high risk medication use, diabetes treatment, drug-drug interactions and diabetes medication dosing. “ It was noted that additional details are in development that will identify beneficiary, prescriber, or pharmacy outliers and provide actionable information to the Plans related to these measures.

During a lively question and answer session, Dr. Ketcham indicated that CMS intends to expand the performance measure set and will continue to explore ways to expand the measure set to provide useful information to beneficiaries and increase its monitoring efforts of the plans. CMS places emphasis on endorsed measures that can be attributed to the Part D plans. PQA’s work to develop and shape future measure concepts is important to CMS and that measure uptake and implementation by stakeholders is critical.
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PQA Welcomes New Member First DataBank

First DataBank, a subsidiary of Hearst Corporation, drives patient safety and healthcare quality by providing drug databases that are used within information systems that touch every aspect of healthcare. For more than 30 years the company has partnered with system developers to integrate and optimize drug information to improve user workflow and enhance clinical decision making by those entrusted with treating patients at the point-of-need. First DataBank works with partners to help reduce the incidence of medication errors and adverse drug events, which promises to lower healthcare costs and improve patient care.

First DataBank supports drug knowledge base implementations - ranging from pharmacy dispensing and claims processing to emerging applications including computerized physician order entry (CPOE), electronic health records, electronic medical records, electronic prescribing, medication reconciliation, disease management and electronic medication administration records (EMAR).
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