IN THE POST-AFFORDABLE CARE ACT (ACA) era, quality in healthcare is one of the most important concepts in patient care. To promote accountability and evidence-based care, the ACA allows multi-stakeholder groups to provide input to the Department of Health and Human Services on selecting quality and efficiency measures.
As part of ASHP’s Pharmacist Accountability Measures, a group of ASHP members known as Quality Advocates have become integral parts of these groups. The advocates serve on various committees, work with administrators and clinicians from other health professions to build consensus, and use their knowledge and training to provide the pharmacist’s point of view on quality measurements that will affect patient care.
“Close to 40 percent of clinical quality measures are related either directly or indirectly to medication use. Pharmacists have the background to assess the scientific reliability and applicability of these quality measures, and are well-suited for offering ideas on how a proposed measure would be implemented in real practice,” said Shekhar Mehta, Pharm.D., M.S., ASHP’s director of clinical guidelines and quality improvement.
One of the ways that ASHP promotes quality healthcare measures is by being a member of the Pharmacy Quality Alliance (PQA), an organization that promotes appropriate medication use and measures and reports performance related to medications.
“We have at least one member in each of seven workgroups and a few on special task forces,” said Mehta. “The director approaches us specifically if there is a gap in clinician involvement because the PQA recognizes the insights that only frontline pharmacists can provide.
“That is one example of why it’s so important to have an organization with ASHP’s resources, experience, and historical perspective invited to the table,” he added. “We’re fortunate to have so many members involved in driving quality improvement.”
The National Quality Forum
ASHP was one of the founding members of the National Quality Forum (NQF), a nonprofit consensus development organization that endorses quality measures and provides recommendations for programs. Much of this work is done through various workgroups and committees on which several ASHP members serve.
“ASHP is very proactive in promoting involvement in these committees,” said Joel C. Marrs, Pharm.D., FNLA, BCPS, BCACP, CLS, assistant professor at the University of Colorado’s Skaggs School of Pharmacy in Denver. Marrs serves on the NQF’s Cardiovascular Steering Committee. “I’m not aware of other organizations that promote membership involvement and encourage their members to apply and serve in these roles like ASHP does.”
ASHP helps to identify pharmacists with specialized experience in particular practice areas and who have experience with quality improvement. Practitioners who are interested in participating in an NQF committee must undergo a rigorous application process to ensure no conflicts of interest. Once on a committee, participants review proposed measures and provide insight based on their practice areas.
“The caveat is that you’re not representing ASHP, yourself, or your employer. You’re acting as an expert in your field,” Marrs said. “But ASHP does a good job of identifying members who would do well on these committees and who will support pharmacy in general.”
Participating in an NQF committee requires time and dedication, said Keith M. Olsen, Pharm.D., FCCP, FCCM, professor and chair in the Department of Pharmacy Practice at the University of Nebraska College of Pharmacy in Omaha. Olsen served on the NQF Surgery Steering Committee.
“We have weekly teleconferences to discuss the measures, and it takes time to prepare for them,” Olsen said. “You have to read the measures and study the literature as well as the format you have to use to do the evaluations. It’s a commitment, not something you should take lightly. Know what you are getting into.”
Pharmacists Excel at Identifying Quality Measures
Olsen said that pharmacists, in particular, often excel at prepping for the evaluations. “It goes along with our training in learning how to read the literature, perhaps more than in other professions,” he said. “We are trained to look for high-quality evidence and good methodologies.”
That ability to recognize whether a measure is supported by evidence served Curtis D. Collins, Pharm.D., M.S., BCPS AQ-ID, FASHP, clinical pharmacy specialist in infectious diseases at St. Joseph Mercy Health System, in Ann Arbor, Mich., well in his work on the NQF’s Infectious Disease Endorsement Maintenance in 2012.
“Each of us would give preliminary recommendations on six or seven measures, and there were important criteria to measure,” he said. “We needed to ask ourselves if the measures had the potential to drive improvements. If so, what is the scientific acceptability of the measures? Could we make valid conclusions about what we were collecting? Was it usable? Feasible?”
The answer was not always “yes,” according to Collins. “There were a few measures that were very ingrained in healthcare that I initially thought would pass, but once we looked at the actual evidence, it required re-review.”
CMS Technical Expert Panels
Karen B. Farris, Ph.D., the Charles R. Walgreen III professor in pharmacy administration at the University of Michigan College of Pharmacy, Ann Arbor, has worked with two technical expert panels funded by the Centers for Medicare & Medicaid Services (CMS)—one on MTM and one on care transitions.
Her current TEP work focuses on hospital outcomes measures for care transitions for patients hospitalized with acute myocardial infarction, heart failure, and pneumonia. Farris, who also had previous experience on NQF committees and was recommended by ASHP to serve on the TEP for care transitions lead by the Yale Center for Outcomes Research & Evaluation, now sees the process from the payer’s side.
“We all recognize that there are pros and cons to any proposed measure or change, but it’s not a closed process at all,” she said. “We need insights from clinicians, administrators, and researchers who think about these measures and whose practices these measures will affect before the measures are opened for public comment and ultimately approved for use.”
Farris stressed the importance of pharmacists having a voice.
“Pharmacy professional organizations like ASHP must be at the table during discussions of quality indicators because all of our institutions will be affected by them,” she said.
“Even on the primary care side, we have pharmacists involved in improving care in physicians’ offices and across the range of care that ASHP represents.”
Farris believes that pharmacist involvement is crucial for her TEP in particular. “We need to ensure that pharmacists are involved because care transitions can be affected by medications. We need to ensure that the right care team is involved in transfers, and pharmacists are a key part of that team.”
Mehta noted that ASHP is always seeking the involvement of members who have experience with quality improvement and performance measures for participation in these groups.
“This an optimal time to get involved because we are seeing healthcare realize the benefits of integrated team-based care that includes pharmacists,” he said. “As medication-use experts, pharmacists’ involvement in measurement development or quality improvement is a critical component of advancing healthcare quality and patient care.”
Although competition is stiff for NQF, CMS-TEP, and PQA participation, and most who are appointed to committee positions are at least mid-level in their careers, there are ways that young pharmacists can get involved, according to Collins.
“This is something you can work on locally and even at the level of your own health system or hospital,” he said. “Some of the measures that [NQF and others] consider were conceived by people who initially tried to improve the care of patients within their own departments or care settings.”
–By Terri D’Arrigo
Editor’s note: The above story is the first of a two-part series on how ASHP members are influencing and steering national quality measures. Click here to read the second story.