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.

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.

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.

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.

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.

Pharmacy Services ⇑ top

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.

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.

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.

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.

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.

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.

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.

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.

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