PQA Annual Meeting is Set for June 1-3, 2011 in Washington, DC: REGISTER TODAY!
Beyond Healthcare Reform: Moving into the Next Chapter of Quality & Accountability

This is the meeting you don't want to miss! The PQA 6th Annual Meeting will kick-off on Wednesday, June 1st at 1PM at the Omni Shoreham in Washington, DC with healthcare leaders presenting the state of the industry from a variety of perspectives including lessons learned from physicians and hospitals on pay for performance, along with a look at Medicare Part D's Star Ratings and a deeper look at how PQA measures are being implemented in the marketplace. There will be interactive panel discussions as well as ample time for questions and answers.

That evening, PQA will host its inaugural Quality Awards & Recognition Dinner. Attendance at the dinner requires a ticket ($75 for all PQA members and non-members) and it is sure to be a wonderful event

The second day of the meeting will include the very popular breakout sessions covering important and relevant issues in healthcare quality and the impact of PQA on the quality performance measurement enterprise. A key goal is to provide attendees opportunities to tap into the resources and network with the experts in quality and performance measurement. Ample time will be provided for networking and for renewing or building relationships with the diverse group of professionals and healthcare stakeholders in attendance. There is no charge to attend the PQA Annual Meeting for PQA members. For non-members there is a $350 registration fee. PQA ANNUAL MEETING BROCHURE AND REGISTRATION FORM

New this year, the PQA Annual meeting will be directly followed by a jointly-hosted PQA/URAC Medication Adherence Summit that begins at 1:00 PM on June 2nd. This unique event will feature presentations focusing on understanding the payer's perspective, trigger points for patients and the science behind improving medication adherence.

There will be a networking reception on Thursday evening. The next morning, experts will delve into the evidence surrounding medication adherence and the impact of pharmacist interventions on patient's behavior. The Summit boasts an impressive line-up of speakers including Carolyn Clancy, MD, Director, Agency for Healthcare Research & Quality giving the final keynote. The meeting concludes at 12 noon on June 3rd. There is a $350 registration fee for all attendees (PQA members and non-members). MEDICATION ADHERENCE SUMMIT BROCHURE AND REGISTRATION FORM

Another first...this year the PQA Annual Meeting will feature exhibit space for 14 companies to highlight their products and services. The exhibit program is designed to give each exhibitor maximum visibility at both the Annual Meeting and the Adherence Summit. EXHIBITOR INFORMATION
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PQA Announces Workgroup Co-Chairs for 2011

Much of the success of PQA is due to member-driven workgroups that diligently gather via phone-based meetings to ensure successful completion of consensus driven goals and objectives for the organization. This year seven workgroups will meet monthly from March through November to accomplish their key initiatives. The 2011 workgroups include: Adherence, Communication, Education, MTM and Care Transitions, Overuse, Pain Management, and Safe Dispensing. Another workgroup, State and Federal Issues, will convene this spring and meet quarterly. Additionally, the Quality Metric Expert Panel meets on an ad hoc basis to discuss various issues related to PQA measures and measure concepts.

Each workgroup is led by two dedicated Co-Chairs who volunteer their time and talents over the year. PQA is pleased to announce the 2011 Co-Chairs for the following workgroups:

Dr. Edmund Pezalla of Aetna Appointed as AHIP's Representative to the PQA Board of Directors

Dr. Edmund Pezalla, MD, MPH, National Medical Director for Pharmaceutical Policy and Strategy at Aetna was appointed to the PQA Board of Directors to serve as America's Health Insurance Plans' representative to the PQA Board of Directors. Dr. Pezalla assumes the Board position that Karen Ignagni, President and CEO of AHIP, has held since PQA's inception. AHIP was a founding member of PQA and was one of the initial organizations brought together by CMS to launch PQA back in early 2006. AHIP took the leadership role and housed PQA for its first two and a half years. PQA's Board recognizes and appreciates the insights and guidance provided by AHIP's senior leadership team to ensure the success of the Alliance.

Dr. Pezalla is responsible for the integration of pharmacy policy and activities into Aetna's overall strategy and operations and reports directly to the Chief Medical Officer. Dr. Pezalla also serves as the lead clinical spokesperson for Aetna in pharmacy-related issues and represents Aetna on industry work groups and conferences. Previously, Dr. Pezalla was Chief Clinical Officer for Aetna Pharmacy Management. In that role, he was responsible for formulary development, quality and utilization programs and clinical strategy.

Dr. Pezalla has more then 20 years of experience in managed care and related areas. Prior to working at Aetna, he was Vice President of Clinical Services for Prescription Solutions, a wholly-owned pharmacy benefits management subsidiary of United Health. Dr. Pezalla was also a health services research fellow and lecturer in pediatrics at the University of Michigan and ran a consulting practice serving managed care firms. PQA welcomes Dr. Pezalla onto its Board and looks forward to his input and expertise to help guide the Alliance's initiatives as part of its 17-member board of directors. Back to Top

PQA Quality Forum Lecture Series
Patient Safety Organizations (PSOs): Sharing the Goal of Improving Quality and Safety in Health Care Delivery

Please join us for the PQA Quality Forum Lecture on Thursday, April 14th at 1 PM EDT. A dynamic trio of speakers will address the topic of Patient Safety Organizations (PSOs): Sharing the Goal of Improving Quality and Safety in Health Care Delivery. One of the speakers is Diane Cousins, RPh, who currently serves as Health Scientist Administrator with the Agency for Healthcare Research and Quality's Center for Quality Improvement and Patient Safety where she had lead Patient Safety Organization Operations since March 2009. The Agency for Healthcare Research and Quality (AHRQ) administers the provisions of the Patient Safety Act and the Patient Safety Rule dealing with PSO operations. Diane Cousins will be joined by both Tara Modisett, Executive Director of the Alliance for Patient Medication Safety and Michael Cohen, RPh, MS, ScD, President of the Institute for Safe Medication Practices (ISMP). Both the Alliance for Patient Medication Safety (APMS) and the Institute for Safe Medication Practices are federally recognized Patient Safety Organizations.

Patient Safety Organizations (PSO) were established in 2005 by The Patient Safety and Quality Improvement Act, with the goal of improving the quality and safety of health care delivery. Organizations that are eligible to become a PSO include: public or private entities, profit or not-for-profit entities, provider entities such as hospital chains, and other entities that establish special components to serve as a PSO.

The Patient Safety Act encourages clinicians and health care organizations to voluntarily report and share quality and patient safety information without fear of legal discovery. By providing both privilege and confidentiality, PSOs create a secure environment where clinicians and health care organizations can collect, aggregate, and analyze data, thereby improving quality by identifying and reducing the risks and hazards associated with patient care.

Register for this complimentary, one-hour lecture at lectureregistration@PQAalliance.org no later than Tuesday, April 12th at 5 PM EDT. Back to Top

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

The study involved focus groups of 276 physicians and office staffers as well as surveys of 157 prescribers across 6 states. The physicians used 1 of 6 different e-Rx software systems at the time of the survey (2006). Of the e-prescribers who completed the survey, 50% felt that safety had improved somewhat and 35% felt that safety was much better as a result of e-Rx. However, there were substantial differences in these opinions across the different types of e-Rx software used by the prescribers. Because the investigators blinded the responses about the specific software packages, it was not possible to ascertain which software was perceived as best at improving safety.

A consistent theme within the focus group discussions were medication lists. The prescribers indicated that having access to a medication list was one of the most important features of e-Rx systems. The prescribers especially liked to see what medications had been prescribed by other clinicians and felt that this information could be crucial for medication reconciliation. However, many of the responses also indicated that clinicians are troubled by the "noise" within the medication lists wherein there are many inactive prescriptions listed and it is not always clear which medications are actually being taken by the patient.

Some of the most common errors associated with e-Rx systems stem from inappropriate selection of the product from drop-down lists. Some e-Rx software provides the prescriber with a long-list of all products that contain the name of the medication entered by the physician. Since the prescriber may not be familiar with all of the different versions of a specific drug, they may guess at which product to "click" on the drop-down list. Since the time of this study in 2006, several software vendors have made significant strides in simplifying the selection of the correct product; however, these problems still exist for many prescribers.

Why This Study is Relevant

PQA has focused on patient safety in several of its workgroups over the past 5 years, including a new workgroup for 2011 that will identify best practices for safe dispensing. In order to identify best practices, it is helpful to have evidence from real-world studies of strategies for reducing errors. This study is helpful in identifying the common types of e-Rx errors. E-prescribing can be an important component of a safe medication-use system, but it is important that we gather more information on new types of errors that stem from e-prescribing as well as identify successful strategies implemented by pharmacies to overcome e-prescribing problems. The Alliance for Patient Medication Safety (a patient safety organization affiliated with the National Alliance of State Pharmacy Associations) is actively seeking feedback from pharmacists on e-prescribing problems. PQA and the Institute for Safe Medication Practices (ISMP) are also collaborating on efforts to share best practices across pharmacy providers on medication safety. We encourage pharmacists to share their experiences and solutions in dealing with e-prescribing practices so that we can all improve the safe care of patients.

This study also highlights the need for better systems of medication reconciliation, particularly for patients who see multiple prescribers or who experience a transition in care setting (e.g., discharged from hospital to home). E-prescribing systems, and the medication lists available through these systems, can be helpful in viewing the patient's medication history; however, there is still a need for someone to reconcile the lists after every change in medications. We cannot rely solely on the e-Rx system to reconcile the medication regimen and ensure that it is an accurate reflection of what the patient is currently taking AND that it is an appropriate regimen for that patient. As many pharmacists have seen, patients who undergo a transition in care will often wind up with duplicative or conflicting therapies. PQA's workgroup on MTM & Care Transitions is continuing to identify ways in which pharmacists and other clinicians can collaborate to ensure that all patients' have a reconciled medication regimen as a component of a patient-centered healthcare home.

Highlighted Article:
1. Lapane KL, Waring ME, Dubé CE, Schneider KL. E-Prescribing and Patient Safety: Results from a Mixed-Method Study. Am J Pharm Benefits. 2011;3:e24-e34. Back to Top

PQA Provides Comments on Core Set of Measures for Medicaid

The Agency for Healthcare Research and Quality (AHRQ) called for comments on their initial Core Set of health quality measures for Medicaid-eligible adults. PQA thanked the Agency for including a representative from the Alliance on the Subcommittee and praised the comprehensive process used by AHRQ to identify the measures. PQA generally agrees with the work of the Subcommittee, but did provide the following recommendations.

PQA suggested the Subcommittee consider ways to minimize the reporting burden on state Medicaid programs. For example, a smaller set of measures within the Core Set could be recommended to states as high priority. This high priority list of measures would pertain to the most common conditions in the Medicaid population, use readily available data sources, and reflect measures currently in use by multiple Medicaid programs. PQA commented that certain measures that utilize chart review or other data sources not easily available could be listed as low priority or temporarily held in the Initial Core Set. While these may be excellent measures, the burden to report may outweigh the benefit until data is more accessible.

PQA commented on the Proportion of Days Covered (PDC), measure #44, in the Core Set. This PQA measure includes rates for five therapeutic categories. Of these, PQA recommended using three rates as high-priority for the Core Set - Angiotensin-Converting Enzyme Inhibitors/Angiotensin-Receptor Blockers (ACE-I/ARB), Statins and Oral Hypoglycemic Agents. These three rates are used in the Medicare Part D Plan evaluation system and could be used for comparison across Medicare dual-eligible and Medicaid-only patient populations.

The Advisory Council Subcommittee will reconvene this spring to consider comments and make final recommendations. Back to Top

USP Proposes New Prescription Labeling Standards: Comment Period Ends March 31st

Medication misuse has resulted in more than 1 million adverse drug events per year in the United States. Patients' best source and often only source of information regarding the medications they have been prescribed is on the prescription container label. In an attempt improve patient safety and medication use appropriateness, USP is seeking comments from pharmacists and other healthcare professionals for the newly proposed General Chapter 17, "Prescription Container Labeling", which appears in Pharmacopeial Forum (PF) 37(1). The deadline for comments is March 31, 2011.

This proposed standard focuses on patient-centered label standards for the format, appearance, content, and language of prescription medication instructions on prescription containers to promote optimal patient understanding. The standard could be adopted by state boards of pharmacy, other governmental authorities, or by conformity assessment bodies for incorporation into state laws, regulations, guidelines, or other documents. The key recommendations for promoting and improving patient understanding around medication use include:

Some examples of the specific recommendations for pharmacies in creating Rx labels include: emphasize the most important information at the top, including the patient's name, drug name, drug strength, and instructions; avoid Latin terms, use simple concise language, and make instructions explicit (ie, "Take 2 tablets in the morning and in the evening" instead of "Take two tablets twice daily"); use at least 12-point font printed in black on a plain white background.

"The label is often the only source of information that the patient has available at home. Years of research have shown that labels as currently presented are mostly unusable by patients," said Joanne Schwartzberg, MD, Co-Chair of the USP Health Literacy and Prescription Container Labeling Advisory Panel, which developed the proposed standards. The proposed General Chapter 17 was developed in the 2005-2010 cycle by the Health Literacy and Prescription Container Labeling Advisory Panel (now known as the is now the Prescription Container Labeling Expert Panel). The Panel developed the proposed standard as a result of a meeting on Health Literacy sponsored by the Institute of Medicine and resulting call for standards for prescription container labeling.

Once USP standards are enacted, they become the standard of care. That leaves states, and pharmacies in those states, open to legal challenge in cases of patient harm that might be linked to labels that do not conform to the new standards.

For specific information go to http://www.usp.org/pdf/EN/USPNF/M5531.pdf.  If you have questions, please contact Shawn C. Becker, M.S., R.N., Director, Healthcare Quality Standards at 301-816-8216 or scb@usp.org. Back to Top

PQA Welcomes New Member

Catalina Health Resource® (CHR®) provides clients with an unmatched opportunity to reach consumers as they seek answers about their health care. The CHR® network touches over 40% of all prescriptions filled in U.S. retail pharmacies and delivers over 1.4 billion messages to more than 132 million consumers every year. The company provides direct-to-patient communication in more than 18,000 pharmacies for many of the nation's leading pharmaceutical, over-the-counter (OTC) and consumer packaged goods (CPG) companies. CHR® has a deep understanding of consumers through its impressive database and new health consumer insights that define a patient's health care journey. Coming soon, CHR will be expanding into the physician's office to deliver direct-to-patient communication via a unique partnership with McKesson Corporation and RelayHealth. Back to Top