Issue 5, March/April 2010

The mission of the PQA is to improve the quality of medication use across health care settings
through a collaborative process in which key stakeholders agree on a strategy for
measuring and reporting performance information related to medications.

Mark Your Calendar:  PQA ANNUAL MEETING Set for June 2nd & 3rd, 2010 in Crystal City, VA!

Don’t miss the informative sessions and networking opportunities!

This meeting will feature a new format spanning two days, and will include breakout sessions covering important and relevant issues in healthcare quality and the impact of PQA on the quality performance measurement enterprise. The meeting design includes face-to-face breakout sessions for the PQA workgroups.  A key goal is to provide attendees opportunities to tap into the resources and experts in quality improvement and performance measurement throughout other quality initiatives within states, and at a regional and national level. Ample time will be provided for networking and for renewing or building relationships with the diverse group of professionals in attendance.

A preliminary agenda and registration form will be available on the PQA website (www.pqaalliance.org) beginning on March 23rd. Registration is complimentary for PQA members, and those who hold an appointment on a 2010 workgroup through a PQA member organization. The registration fee for this two day meeting for non-members is $395. For additional information please direct email inquiries to info@PQAalliance.org 

Sponsorship opportunities are available for this meeting.  For further information please contact Jackie Green, at jgreen@pqaalliance.org or 703-927-1599. Back to Top

PQA Announce its Workgroup Lineup and Leadership for 2010:Workgroups’ Get Underway

At the beginning of each year, PQA undergoes a thorough review of the infrastructure of the organization—the workgroups, councils and panels that are relied upon to continue to move the PQA strategic plan forward and to consistently promote appropriate medication use and to encourage performance measurement strategies that facilitate better quality and value. The PQA workgroups are critical to these efforts.

NOTE: if you are a PQA member and have not submitted your 2010 workgroup selections, please do so to Karen Peterson (kpeterson@PQAalliance.org) or fax your form to 703-690-1756 as soon as possible.  Workgroup appointments from 2009 do not carryover to 2010, so please don’t miss out!

Quality Metrics Workgroups
The 6 quality metrics workgroups for 2010 will be focused on the following areas:

Misuse/Overuse of Medications
Chair:
David Domann, MS, RPh, Director, Health Policy Advocacy and Quality, Ortho-McNeill-Janssen Pharmaceuticals

Medication Therapy Management Services
Co-Chairs:   
Julie Kuhle, RPh, Pharmacy Director, Iowa Foundation for Medical Care
Charles (Vic) Spain, DVM, PhD, Epidemiologist, US Outcomes, Merck

Palliative Care and Pain Management
Co-Chairs:   
Kevin Bain, PharmD, MPH, CGP, Vice President, Clinical Support, excelleRx, Inc.
Todd Berner, MD, Health Outcomes and Pharmacoeconomics, Endo Pharmaceuticals

Patient Safety:
Co-Chairs:   
Kelly Chillingworth, RPh, CGP, Clinical Program Manager, MedImpact Healthcare Systems
Carey Cotterell, RPh, FAMCP, Kaiser Permanente Consultant

Population Health:
Co-Chairs:   
Jean Venable-Goode, PharmD, BCPS, Professor and Director, School of Pharmacy, Virginia Commonwealth University
Kathleen Shoemaker, PharmD, MBA, Federal and Quality Accounts, Lilly USA,       

The Role of Medication Management Programs in Care Transitions & the Patient Centered Medical Home
Co-Chairs:   
Karen Farris, RPh, PhD, Professor, Pharmaceutical Socioeconomics, College of Pharmacy, University of Iowa
MaryAnn Kliethermes, PharmD, Vice Chair, Ambulatory Care, Chicago College of Pharmacy, Midwestern University

Measure Uptake and Implementation Strategies Workgroups
These four workgroups are a forum for dialogue and strategic discussions about how measures are adopted in various sectors. A key focus is what PQA can do to consistently build awareness and encourage adoption of the PQA/NCQA measures.

Consumer Engagement/Experience:
Co-Chairs:   
David Medvedeff, PharmD, CEO, Avatar International LLC
N. Lee Rucker, MSPH, Senior Strategic Policy Advisor, Public Policy  Institute, AARP 

PBMs, Insurers, and Health Plans:
Co-Chairs:   
Woody Eisenberg, MD, Vice President and CMO, Medicare, Medco Health
Bimal Patel, PharmD, MS, Director, Health Outcomes Research, MedImpact  Healthcare Systems, Inc.

Public Payors at the Federal Level:
Co-Chairs:   
Vikki Oates, MAS, Director, Division of Clinical and Operational Performance, CMS
Kim Caldwell, RPh, Director, Competitive Health Analytics and Humana Pharmacy Solutions eRx, Humana

Public Payors at the State Level:
Co-Chairs:   
Elgene Jacobs, PhD, Associate Professor, University of Oklahoma Health Science Center & Executive Director, American Drug Utilization Review Society
Brendan Joyce, PharmD, Pharmacy Administrator, North Dakota Medicaid

Communication & Education Workgroup
The continued education of practitioners and the engagement of pharmacy providers on issues pertaining to performance measurement will remain a high priority throughout 2010.

Additional objectives of this group will be to disseminate the research findings of the PQA demonstration projects and to identify key topics for PQA’s increasingly popular monthly Quality Forum Lecture Series. This group will continue to work on communication tools and vehicles such as PQA’s Quality Connection, our bi-monthly e-newsletter. They will also seek out additional opportunities to integrate PQA members into the broader performance measurement community.

Co-Chairs:  
Terri Warholak, PhD, RPh, Assistant Professor, The University of Arizona College of Pharmacy
Frank Kondrad, Director, Managed Markets, AstraZeneca

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Hot Off the Press: Rapid Reviews of Key Quality Publications and Studies
by David Nau, PhD, RPh, CPHQ, Senior Director, Research & Performance Measurement, PQA

It has been 10 years since the Institute of Medicine (IOM) issued its highly-regarded report on medical errors entitled To Err is Human.  Five years ago, Robert Wachter of the University of California – San Francisco provided an assessment of how well the healthcare system had responded to the IOM recommendations for patient safety.  He gave us a grade of C+ at that time.  In the January 2010 edition of Health Affairs, Dr. Wachter provides an update on his assessment with the article “Patient Safety at Ten: Unmistakable Progress, Troubling Gaps.”  His newest grade for patient safety is a B-. 

Dr. Wachter evaluated our progress on ten key patient-safety domains and gave each domain a separate grade.  The grades ranged from C+ to A- with the highest grade in the domain of “national and international organizational interventions.”  For this domain, the author notes significant recent efforts by AHRQ, NQF, IHI, WHO, Joint Commission and other organizations devoted to patient safety and healthcare quality.  However, Wachter also points out that the enthusiasm for more stringent accreditation standards can sometimes push too far, too fast.  He cites the example of the Joint Commission enacting a 2005 National Patient Safety Goal for medication reconciliation without clear guidance on how to safely reconcile medications.  Wachter views The Joint Commission’s recent announcement that it would suspend grading hospitals on medication reconciliation as evidence that this particular goal was enacted prematurely.

Health information technology (HIT) was noted as having “surprisingly low uptake over the past 5 years” although Wachter gave the domain a C+ because of recent federal funding for HIT.  As the author notes, the implementation of HIT is much harder than many anticipated.  The significant costs of HIT systems, the failure of some vendors, and the recognition of new errors that result from computerized order entry are some of the factors that have slowed progress.  The federal government’s recent commitment of $19 billion to spur adoption of HIT, and recent physician incentives via CMS to adopt e-prescribing may help to accelerate progress.

Why This Study is Relevant

Medications are an important tool in treatment of disease but can also be the subject of many medical errors.  Pharmacists must continue to assert their role in promoting the safe use of medications.  This not only includes the safe dispensing of medications, but efforts to support safe prescribing, administration and consumption of medications.   As noted in the article by Wachter, there is still significant room for improvement in patient safety and no single organization or practitioner can solve all problems.   The FDA recently launched a Safe Use Initiative to increase its attention to how medications are used, and to broaden its safety efforts beyond the approval of drugs for marketing.  CMS will also continue to expand its attention to medication safety through multiple channels.  PQA plans to collaborate with the FDA, CMS and other entities in promoting the safe and effective use of medications.   By working collaboratively, we hope to enhance the impact of PQA on the quality and value of the healthcare system.

Highlighted Article:  Wachter RM. Patient Safety at Ten: Unmistakable Progress; Troubling Gaps. Health Affairs. 2010;29:165-73.

Additional Articles Worth Reading: 

Blackwell SA, et al.  National study of medications associated with injury in elderly Medicare/Medicaid dual enrollees in 2003. J Am Pharm Assoc. 2010;49:751-9.

Morden NE, et al.  Quality of care for cardiometabolic disease. Associations with mental disorder and rurality.  Med Care. 2010;48:72-78.

Selby JV, et al.  Meaningful variation in performance: What does variation in quality tell us about improving quality?  Med Care. 2010;48:133-39.
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Educate Yourself on Pay-for-Performance (P4P)

In the article Nau states “If the quality of medication utilization is an important factor in the overall value of health care, it makes sense to incentivize all providers who can impact the use of medications. Physicians have been participating in P4P programs wherein medication measures are used to determine the physician’s payment. If pharmacists can affect the quality of medication use, then it stands to reason that pharmacists or pharmacies be included in P4P systems. The inclusion of pharmacists in P4P programs can signal the recognition of the profession as an important component of safe and effective care.”

To access the entire series of educational activities (listed below)  and the related continuing pharmacy education go to www.TheCEInstitute.org/PharmacyQuality.aspx.

Advancing Pharmacy Performance Through Quality Measurement Series:

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Quality Metrics Expert Panel – Review of New Measure Concepts

The Quality Metrics Expert Panel (QMEP) is charged with evaluating the measure concepts proposed by the PQA workgroups and to prioritize the measure concepts for specification and testing.  In 2009, the QMEP conducted reviews of the 28 measure concepts that were presented at the November 2008 PQA membership meeting and also reviewed 8 measure concepts that were presented at the November 2009 membership meeting. The panel held multiple conference calls during September 2009 through February 2010. All members of the panel were asked to submit written reviews of the measure concepts prior to the calls.

The measure concepts were evaluated on the following criteria: 1) Importance for Quality Improvement; 2) Feasibility for Measurement; 3) Usability by Pharmacists or Drug Plans; 4) Scientific Acceptability.  For measure concepts that were deemed to be important, feasible and potentially usable for quality improvement, the concepts were then prioritized.   These high-priority measures will then move forward for development of technical specifications and then testing with real-world data. The QMEP will review the technical specifications and testing results in order to make a final recommendation to PQA regarding the endorsement of the new measures.  
The following measure concepts were recommended for specification and testing:

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PQA Welcomes New Members

American Drug Utilization Review Society (ADURS) is composed of members active in drug utilization review (DUR) of the 50 State and District of Columbia Medicaid programs. The mission of ADURS is to provide a forum of leadership and support for the membership to obtain information, develop skills and receive training to efficiently and effectively perform their duties. The focus of its members’ duties is the achievement of optimum health care outcomes.

Takeda Pharmaceuticals North America, Inc. is among the top 15 pharmaceutical companies in the United States. Founded in 1998 to accelerate Takeda’s global expansion into the U.S. market, Takeda started with three employees and is now one of the fastest growing pharmaceutical companies in the United States, employing more than 5,500 people.  Takeda’s primary goal is to strive to deliver medicines to patients, innovate in the areas of research and development, and foster fruitful industry partnerships. Back to Top