The findings of low patient adherence and the impact of adherence on relapses and healthcare resource utilization strongly suggest opportunities to reduce healthcare resource utilization and healthcare costs among RRMS patients taking interferon-beta therapy. Efforts should be undertaken to understand and improve medication-taking behaviour in this population so as to minimize the negative impacts of RRMS on patients while reducing unnecessary direct and indirect costs to treat disease exacerbations.

BACKGROUND Epoprostenol and treprostinil are intravenous prostacyclin medications used to treat pulmonary arterial hypertension (PAH). This survey explored hospital policies regarding prostacyclin infusions, and investigated the type and frequency of errors that occurred in the inpatient setting. METHODS Information on prostacyclin infusion policies and inpatient errors was obtained through detailed interviews with 18 PAH nurses, and through an electronic survey completed by 97 PAH clinicians. RESULTS The electronic survey respondents reported wide variability in prostacyclin infusion policies, including variability in the use of home vs hospital infusion pumps, and variability in the use and storage of back-up epoprostenol and treprostinil. Serious or potentially serious errors in medication administration were reported by 68% of survey respondents. The most common error types (reported by ≥25%), included: incorrect cassette placed in the pump; inaccurate pump programming; errant drug dosing; and inadvertent cessation of the pump. Nine errors, all at different centers, were believed to have contributed to patient death. In the separate interviews with the PAH nurses, 94% reported serious errors. These errors prompted many of the centers to implement policy changes in an attempt to reduce future errors, improve safety and optimize patient outcomes. CONCLUSIONS These findings suggest that prostacyclin infusion therapy is problematic and that an opportunity exists to improve safety. The development of standardized treatment guidelines should be considered.

BACKGROUND-Epoprostenol and treprostinil are intravenous prostacyclin medications used to treat pulmonary arterial hypertension (PAH). This survey explored hospital policies regarding prostacyclin infusions, and investigated the type and frequency of errors that occurred in the inpatient setting. METHODS-Information on prostacyclin infusion policies and inpatient errors was obtained through detailed interviews with 18 PAH nurses, and through an electronic survey completed by 97 PAH clinicians. RESULTS-The electronic survey respondents reported wide variability in prostacyclin infusion policies, including variability in the use of home vs hospital infusion pumps, and variability in the use and storage of backup epoprostenol and treprostinil. Serious or potentially serious errors in medication administration were reported by 68% of survey respondents. The most common error types (reported by ≥25%), included: incorrect cassette placed in the pump; inaccurate pump programming; errant drug dosing; and inadvertent cessation of the pump. Nine errors, all at different centers, were believed to have contributed to patient death. In the separate interviews with the PAH nurses, 94% reported serious errors. These errors prompted many of the centers to implement policy changes in an attempt to reduce future errors, improve safety and optimize patient outcomes. CONCLUSIONS-These findings suggest that prostacyclin infusion therapy is problematic and that an opportunity exists to improve safety. The development of standardized treatment guidelines should be considered.

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DedicationThis dissertation is dedicated to my wife Debbie who has graced me with companionship, love, and support for 33 years. I also dedicate this work to my daughter AbstractThe stated mission of the Board of Pharmaceutical Specialties (BPS) with regard to specialization is, via board certification, to recognize specialty areas, define skill standards for those specialty areas, and evaluate the knowledge and skills of individual Pharmacy specialists. The perceived or real benefits to the pharmacist of pursuing board certification are unknown. These benefits can be evaluated by separating into values (valences) and instrumentalities, the latter of which is the perceived or known probability that a performance will lead to an outcome. The primary purpose of this study was to determine the differences in values and instrumentalities perceived by the pharmacist, and differing calculated forces of motivation, using an Expectancy Valence equation, between board certified pharmacists and those who were not.A survey instrument, the Advanced Certification Index for Pharmacists (ACI-P), was designed to test instrumentalities, values, and calculated force of motivation. The ACI-P was deployed via electronic mail and the internet in cooperation with four major Pharmacy organizations and the Board of Pharmaceutical Specialties. Four direct comparisons between the two groups were completed. These were instrumentality, valence, valence-minus-instrumentality and valence-times-instrumentality. Additionally, the components of the valence and instrumentality products (the VI Scores) were multiplied by expectancy (anticipated chance of success of an effort leading to successful performance) resulting in a force of motivation calculation for each pharmacist's score. Validation and reliability of the ACI-P was confirmed via parallel axis analysis and Cronbach's alpha reliability coefficient. There were two factors or domains found in the data and these were Professional, Career and Personal (PCP) and Financial Support (FS). Cronbach's alpha for the PCP factor or domain was 0.94 and the FS domain had an alpha of 0.81. The constructs were validated and the items addressed within the constructs of PCP and FS were reliable. The overall Cronbach's alpha reliability coefficient for the ACI-P was 0.94.In the four major comparisons, there were significant differences between nonboard certified and board certified pharmacists.The primary value used for the motivational force calculation was based on valence-times-instrumentality-times-expectancy. The valence-times-instrumentality value was the VI score or VIS. The summed VI scores for the non-board certified pharmacists were in general lower (303.54; SD 101) than those for the board certified pharmacists (343.82; SD 83), and these were statistically different (t= -8.03, p<.0001).The overall expectancy mean for non-board certified pharmacists was 4.05 and 4.4 for board certified pharmacists (5-point Likert scale), and these were significantly different (t = -9.16, p<.0001).The overall mo...

59 Background: Radiation oncology practices and health plans typically engage in fee for service (FFS) contractual relationships, which employ utilization management techniques to manage treatment accordance with recognized guidelines. FFS contracts often result in unpredictable revenue streams for practices and burdensome administrative processes for both practices and payers. Moreover, there are limited mechanisms in FFS arrangements for practices and payers to systematically measure quality. Radiation oncologists and health plans share the common goal of systematically improving quality of patient care while reducing administrative burden. Methods: In 2012, Humana collaborated with a large national radiation therapy provider to implement ‘bundled’ case rate reimbursement instead of FFS. The case rate model was developed with HealthHelp, a radiation oncology quality vendor, and the payments were developed in the context of the appropriate modality for each cancer type. Changes in practice patterns were measured in the Medicare population by average fraction ratios across breast cancer, bone metastases, and prostate cancer. Fraction ratios compare delivered fractions to standards established by the National Comprehensive Cancer Care Network guidelines. A ratio of 1.0 means that the delivered amount met the recommended guideline. Ratios nearer to one (over or under) demonstrate appropriate therapy. Ratios were compared for 2011 vs. 2013 using T-tests. Results: Conversion from a FFS to case rate reimbursement did not coincide with a change in fraction ratios for breast cancer treatment. Fraction ratios for both bone metastases and prostate cancer moved towards the target ratio of 1.0 after the move to case rate reimbursement. Conclusions: After the implementation of case rate reimbursement, fraction ratios improved for bone metastases and prostate cancer, while breast cancer fraction ratios did not change. Future work will evaluate additional markers of quality and practice efficiency measurements. [Table: see text]