At the end of the chapter, the reader will be able to:
Describe how to interpret a pharmacy quality report from an outside assessment.
Use the quality improvement process to improve quality as identified by an outside assessment.
Apply quality improvement principles to community and hospital pharmacy examples.
If, and only if, providers have to demonstrate excellent results in addressing specific medical conditions will error decline, unnecessary tests not be performed, unnecessary treatments stop, the use of ineffective treatments cease, and the withholding of effective services come to an end.1
The results of quality measurement compiled in a pharmacy performance report can be a valuable tool to assess performance, identify and address quality concerns, and improve patient care. When pharmacy quality performance reports are available to the public, pharmacies can use information about the quality of their services to establish market differences between the health care they provide and service provided by their competition. Pharmacies can use the results in performance reports to differentiate themselves on aspects of patient care or disease management. The reports could also assist consumers in selection of a high-performing pharmacy and could be used by health plans in developing a high-performance pharmacy network. As payment reform leads to incentives based on quality, the mechanism used to give feedback to providers will be performance reports.
Most importantly, quality reports enable pharmacy staff to assess their performance so that patient care quality can be improved and enhanced. The Institute of Medicine defines quality as: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (http://www.iom.edu/CMS/8089.aspx, accessed August 22).
Quality reports allow the user to determine areas for improvement based on the measure score, impact on patient safety, or stakeholder interest. When a pharmacy quality report is received, the pharmacy should consider the following process for optimizing their response. First, pharmacists should understand who has produced the report, why the report was provided, and what the data source for the report is. A payer such as CMS or a Medicare Part D plan may provide the report, or a chain pharmacy organization may provide quality reports to each of their pharmacies. Quality reports typically are used to provide information or comparison, to stimulate practice improvement, or to base an incentive. The data source for many pharmacy quality measures will be prescription drug claims, but some measures may also include diagnostic, laboratory, or administrative information. Pharmacy survey report cards will use subjective evaluation of the pharmacy's services from patient surveys.
The next step is to interpret the results on the performance report. Pharmacists should develop a good understanding of the measures used and how the score reflects on their practice. Most quality reports will include the measure's name and basic specification. The calculation of the measure uses a specified numerator ...