Scientific Contributions

PQA collaborates on diverse, innovative projects using methodologies such as qualitative and quantitative data analysis, expert roundtables, environmental scans, literature reviews, and more. Explore PQA’s scientific contributions below.

Focus Areas: (click on focus area to reach section)

  • Medication Adherence & Safety
    PQA investigates the impact of medication use quality by studying the impacts of medication adherence and safety. Many of our projects generate evidence for PQA quality measures.
  • Medication Access & SDOH
    PQA research is committed to improving care by targeting patients’ unmet social needs and evaluating the barriers to accessing medications.
  • Patient Engagement
    PQA research conducts patient-centered studies that focus on patient experience and patient engagement to incorporate the patient voice in quality.
  • Pharmacy Services
    As pharmacy practice continues to evolve, PQA is committed to investigating the value of pharmacist-provided care models bring to healthcare teams and patient outcomes.

Medication Adherence & Safety

Economic Outcomes Associated with Quality Measure Adherence Definitions

Methodology: Secondary Data Analysis

Collaborators: University of Arizona and Merck & Co, Inc.

Description: The relationships between adherence definitions used in quality measures and healthcare resource utilization and costs were evaluated in this study. Cohorts of patients taking diabetes, statin, and renin-angiotensin system antagonist medications were evaluated in Medicare, Medicaid, and Commercial lines of business. Adherence was associated with lower inpatient utilization, high prescription drug costs, and lower inpatient, outpatient, and total healthcare costs. Adherence was associated with lower per-member-per-month healthcare costs when compared to non-adherence.

Publications and Presentations:

Validation of an Insulin Persistence Methodology for Use in Quality Measurement

Methodology: Secondary Data Analysis

Description: This retrospective cohort study measured treatment persistence among type 2 diabetes mellitus patients initiating basal insulin and investigated the association of insulin persistence with clinical and economic outcomes. The results of this study support other previously published reports of insulin persistence and outcomes, wherein greater insulin persistence was associated with improved hemoglobin A1c values, reduced health care utilization, and lower healthcare costs.

Bleeding Events Associated with Anticoagulant Medication

Methodology: Measurement Science - Feasibility, Secondary Data Analysis

Collaborators: DataIQ, University of Maryland, Optum Labs

Sponsor: American Association of Retired Persons

Description: This project aimed to assess the feasibility of a measure concept titled “Hospital admissions, urgent care, or emergency department visits for bleeding events associated with anticoagulant medications.” The project aimed to characterize the measure concept target population in commercial and Medicare Advantage lines of business and test the feasibility, validity, and reliability of the measure concept. The measure concept was feasible to calculate, but rates were not found to be reliable at the contract-level.

Advancing Insulin Quality Measure Development

Methodology: Measurement Science - Feasibility, Secondary Data Analysis, Convening

Collaborators: Multi-stakeholder technical expert panel

Description: This project assessed the feasibility of two measure concepts titled “Adherence to basal insulin” and “Persistence to basal insulin.” PQA convened a multi-stakeholder technical expert panel to inform draft measure specifications, discuss feasibility testing results, and provide recommendations on the potential advancement of the measure concepts. The “Adherence to basal insulin” measure concept was not approved for measuring performance while the “Persistence to basal insulin” measure concept was recommended to move forward to the next step of PQA’s measure development process.

Advancing Migraine Quality Measure Development

Methodology: Measurement Science - Feasibility, Secondary Data Analysis, Convening

Collaborators: Premier, multi-stakeholder technical expert panel

Description: This project assessed the feasibility of a measure concepts titled “The percentage of patients with migraine that qualify for preventive treatment who receive preventive treatment.” PQA convened a multi-stakeholder technical expert panel to inform draft measure specifications, discuss feasibility testing results, and provide recommendations on the potential advancement of the measure concepts. The measure concept was recommended to move forward to the next step of PQA’s measure development process.

Validation of the Chronic Obstructive Pulmonary Disease (COPD) Treatment Ratio for quality measurement

Methodology: Secondary Data Analysis

Collaborators: GlaxoSmithKline

Description: This retrospective cohort study aimed to validate the optimal predictive value of the COPD treatment ratio (CTR) as a measure of COPD exacerbation risk in Medicare advantage and commercial line of business samples and explore the suitability of CTR use in quality measurement. This study supported previous findings on the optimal predictive value of CTR And found no difference by line of business. Based on these findings, the CTR measure concept will be reviewed by PQA’s 2021 Health Plan Measure Concept Advisory Group, which provides input to assist PQA in prioritizing concepts for new measure development.

Medication Access & SDOH ⇑ top

Access to Care: Medication Access Framework for Quality Measurement

Methodology: Convening, Qualitative, Literature Review, Environmental Scan

Collaborators: National Pharmaceutical Council, multi-stakeholder roundtable

Description: This multi-stakeholder roundtable leveraged findings from literature reviews and an environmental scan to develop a conceptual framework for medication access. The Medication Access Patient Journey (MAPJ) conceptual framework was developed consisting of 7 access nodes (perceived need, help seeing, encounter, prescribing, prescription adjudication, prescription dispensing, and adherence) and is cyclic in nature. The Roundtable also identified 18 common barriers (financial and non-financial) patients encounter across the nodes of the framework. This conceptual framework serves as a foundation for efforts by measure developers, researchers, and other healthcare stakeholders to advance quality measurement for medication access.

Publications and Presentations:

Impact of Health Literacy-Conscious Medication Educational Videos on Primary Medication Nonadherence Rates

Methodology: Secondary Data Analysis

Collaborators: VUCA Health, Liberty Software

Description: This cohort study assessed the impact of an automated, medication counseling video message service on primary medication nonadherence (PMN) rates. Intervention pharmacies offered medication-specific educational video services to patients [via phone or computer] when electronic prescriptions were received (case pharmacies). Pharmacies that utilized medication education videos had significantly lower (better) PMN rates than control pharmacies. Prescriptions from case pharmacies and prescriptions where medication education videos were used were associated with lower odds of PMN classification. This study found health literacy-conscious, patient education videos were associated with improved, or lowered, PMN rates.

Publications and Presentations:

SDOH data procurement and use amongst key healthcare stakeholders

Methodology: Survey

Collaborators: Texas Center for Outcomes Research and Education

Description: This study surveyed PQA members to describe social determinants of health (SDOH) data collection capabilities. The study found that approximately half of healthcare organizations surveyed collect SDOH data. Healthcare stakeholders consider patient SDOH data important but face significant challenges collecting these data. Solutions that address data standardization, time and technological barriers could facilitate its collection and effective use. This study found that participants anticipated an increased focus on addressing SDOH in the future with incentives for collection under value-based payment programs.

Impact of patient out-of-pocket costs for oral anticancer medications on medication adherence

Methodology: Secondary Data Analysis

Collaborators: National Pharmaceutical Council, University of Rhode Island

Description: This retrospective cohort study evaluated trends and relationships between oral anticancer medication patient out-of-pocket costs and medication adherence. This study found that although adherence varied by cancer type, there was overall low adherence to oral anticancer medications. High out-of-pocket costs were one of the most substantial barriers to accessing these medications.

Impact of a Real Time Prescription Benefit Tool

Methodology: Program Implementation & Evaluation

Collaborators: National Pharmaceutical Council, Johns Hopkins University

Description: To our knowledge, this study is the first to date to evaluate the impact of Real Time Benefit Tool (RTBT) use. We found that prescriptions ordered by way of this tool were less likely to be abandoned by patients, less likely to be subsequently cancelled by physicians, and more quickly readied for sale and ultimately sold by pharmacies. The use of RTBT was not found to be associated with any change in the 30-day prescription modification rate.

Examination of pharmacy accessibility in two racially diverse metropolitan areas

Methodology: Literature Review, Secondary Data Analysis

Collaborators: University of Arizona

Description: The purpose of this study was to develop a model to classify levels of pharmacy access in two racially diverse urban communities and to understand what factors impact pharmacy accessibility. Data on demographic and neighborhood characteristics on demographic and neighborhood characteristics such as race/ethnicity, socioeconomic status, vulnerability, culture, residential stability, and transportation were used. Factors that contributed to decreased pharmacy access were unemployment and vacancy rates, health insurance plans, vehicle access, public transport, and walkability. This study also found that walk times and drive time to pharmacies varied by racial demographics.

Patient Engagement ⇑ top

Patient Engagement Rubric

Methodology: Convening, Qualitative, Literature Review

Collaborators: National Health Council, National Quality Forum, multi-stakeholder roundtable

Description: The Patient Engagement in Quality Measurement Rubric was developed to help meaningfully include the patient community (i.e., patients, caregivers, patient advocates) as partners across the quality measure lifecycle. A multi-stakeholder roundtable guided development of the rubric to identify whether engagement is meaningful, progressing or low across four patient-centeredness principles: patient partnership, transparency, representativeness, and meaningfulness. It can be applied in measure conceptualization, specification, testing, implementation, use, continuing evaluation, and maintenance. Activities to improve patient engagement are also described.

Publications and Presentations:

Pharmacy Services ⇑ top

Pharmacist-conducted Immunization Assessment and Documentation

Methodology: Program Implementation & Evaluation

Collaborators: DocStation

Description: This proof-of-concept aimed to develop and describe the implementation of routine immunization status assessment and compliance documentation workflows within a medication therapy management program. Community pharmacists recorded completed immunization assessments and compliance to guideline-recommended adult influenza, pneumonia, hepatitis B, herpes zoster, and tetanus vaccines. Pharmacists completed nearly all immunization screening tasks. Aggregate compliance to the five vaccines was low and compliance rates varied by vaccine type. This study demonstrates the feasibility of a scalable model, aligned with healthcare industry interoperability standards, to collect and report clinical services data in a community pharmacy electronic health record.

Publications and Presentations:

Medication Synchronization in a COPD Population

Methodology: Secondary Data Analysis

Collaborators: GlaxoSmithKline

Description: This propensity score matched cohort study examined differences in chronic obstructive pulmonary disease (COPD) medication adherence, COPD exacerbations, healthcare resource utilization, and healthcare costs among subjects with synchronized medication refill schedules and those with non-synchronized medication refills. Medication synchronization was associated with improved COPD medication adherence, lower severe COPD exacerbations rates, reduced inpatient utilization and lower healthcare costs.

Estimating the Relative Contribution of Community Pharmacists to Prescriber Quality Measures

Methodology: Instrument Development, Secondary Data Analysis

Collaborators: University of North Carolina

Sponsor: Community Pharmacy Foundation

Description: The quality measure impact tool-community pharmacy (QMIT-CP) was developed to evaluate prescriber quality measures that community pharmacists have potential to influence and applied to the 2017 MIPS measure set. Medicare administrative claims data were used to build selected MIPS and Medicare Star Ratings measures to estimate the relative contributions of primary care providers and pharmacists. The residual intraclass correlation coefficient (RICC) was used to estimate of the share of total variation in a quality measure score due to prescriber and pharmacy groups. This study found strong evidence for the impact of pharmacists on medication adherence and high-risk medication use in the elderly measures.

Publications and Presentations:

Pharmacist-Provided Care Survey and Industry Task Force

Methodology: Qualitative, Interviews, Literature Review

Collaborators: Pfizer, Multi-Stakeholder Task Force Participants

Description: PQA conducted a survey and convened an industry task force to identify opportunities to advance pharmacist-provided care in our evolving healthcare delivery system, which is increasingly value-based. The result of the project is an action guide with recommendations for how pharmacies and payers can foster the adoption of pharmacist-provided care and help patients live healthier, longer lives.

Publications and Presentations:

Characterizing Comprehensive Medication Review (CMR) Services

Methodology: Qualitative, Interviews, Literature Review

Collaborators: Merck, University of Arizona

Description: Variation in comprehensive medication review (CMR) content and service delivery was explored in this project. Key CMR components were identified through a scoping literature review and semi-structured interviews with key informants. Real-world CMR call transcript data from three organizations were qualitatively assessed. Discrepancies between real-world data and the key CMR components identified through the literature and key informants were described. Variation in CMR content was also described. Results from this project provide an understanding of the content and delivery of CMR that will be leveraged in subsequent research to inform development and testing of a CMR patient experience survey.

Publications and Presentations:

Impact of Medication Synchronization on Adherence & Economic Outcomes

Methodology: Secondary Data Analysis

Description: This propensity score matched cohort study examined differences in diabetes medication adherence, inpatient admissions, and total healthcare costs among subjects with synchronized medication refill schedules and controls. Medicare supplemental and commercial lines of business were evaluated. Medication synchronization was associated with greater diabetes medication adherence, reduced inpatient utilization and lower healthcare costs.

Improving Influenza and Pneumococcal Vaccination Rates Through a Medicare Advantage-Pharmacy Partnership

Methodology: Program implementation & evaluation

Collaborators: Humana, Pharmacy Quality Solutions, Premier

Description: This quasi-experimental, cluster randomized intervention study used Medicare Advantage Prescription Drug data to determine whether a pharmacist-led intervention could improve vaccination rates for pneumonia and influenza immunizations. Intervention pharmacies received reports of patients with a gap in influenza (ages 19-89 years) and/or pneumococcal (ages 65-89 years) vaccinations based on medical and pharmacy claims history. In multivariable analyses, intervention pharmacies were associated with higher odds of delivering pneumococcal and influenza vaccinations than control pharmacies.

Immunization Services Model for Adult Rate Improvement (ImmuSMART)

Methodology: Program implementation & evaluation

Collaborators: Kinney Drugs, Tops Friendly Markets, Price Chopper, STC, VoicePort

Description: This study assessed the impact of a novel immunization-registry based automated telephonic intervention on adult vaccination rates using prompts for pneumococcal and herpes zoster vaccinations. This randomized controlled trial study found that patients who received a telephonic vaccination prompt were associated with an increased odds of herpes zoster and pneumococcal vaccination compared to those who did not receive an immunization prompt. Intention-to-treat analyses did not result in significant findings.

Health Outcomes Impact of the Appointment-Based Model

Methodology: Program implementation & evaluation

Collaborators: Humana, Pharmacy Quality Solutions, University of Cincinnati

Description: This quasi-experimental study evaluated the impact of an appointment-based model (ABM) on medication adherence, healthcare resource utilization, and costs. Three cohorts of patients taking diabetes, statin, and renin-angiotensin system antagonist medications were evaluated. Participation in ABM significantly increased the odds of adherence for all drug classes and was associated with lower medical costs. No difference in the number of healthcare visits was observed.

Factors influencing specialty pharmacy turnaround time

Methodology: Qualitative, Survey

Collaborators: National Association of Specialty Pharmacy, Pfizer

Description: The objective of this pilot study was to develop medication therapy management (MTM) clinical software infrastructure and workflow for community pharmacists to document and report immunization assessment and compliance status. The pilot found that pharmacists are frequently conducting immunization assessments and provides proof-of-concept that these data can be meaningfully captured in community pharmacy electronic health records. Therefore, MTM platforms in community pharmacies can support the capture of clinical services data in a feasible, scalable, and interoperable way.

Pharmacist-conducted immunization assessment and documentation

Methodology: Program implementation & evaluation

Collaborators: DocStation

Description: A series of focus groups with specialty pharmacists and a cross-sectional survey were used to identify factors that influence specialty pharmacy turnaround time and identify best practices for improving turnaround times. The focus groups, comprised of respondents from specialty pharmacy types including independent, payor associated, health system, and chain specialty pharmacies informed the survey. Facilitators impacting turnaround time included electronic prior authorization systems, implementation of disease teams within the pharmacy, and physician partnerships. Most barriers and facilitators varied by pharmacy type, but prior authorization was a consistent barrier across pharmacy respondents. This study found that there is a need for a standardized turnaround time measure for specialty pharmacy.

Forming consensus on measures that demonstrate the value of community pharmacy practice

Methodology: Convening

Collaborators: Community Pharmacy Foundation

Description: Through a series of virtual meetings, thought leaders from across healthcare formed consensus on a prioritized list of 10 pharmacy quality measure concepts. The group also explored and summarized the feasibility of implementing the measure concepts in terms of data collection, reporting, and interoperability. This analysis helped the group categorize measure concepts into short-, mid-, and long-term readiness for development. TEP panels for short-term readiness measures will be launched in 2022. Mid- and long-term measure concepts can be explored through pilot programs.

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