Measuring Pharmacy Performance in the Area of Medication Adherence: Addressing the Issue of Risk Adjustment

Dharmarajan, Sai; Bentley, John P.; Banahan, Benjamin F.; West-Strum, Donna

doi:10.18553/jmcp.2014.20.10.1057

Cited by 10 publications

(32 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Across multiple disciplines, including pharmacy practice, there is inadequate measurement of fidelity, possibly due to poor under-standing of the concept and/or a lack of validated tools [9,[21][22][23][24]. Implementation of services involves both process and structure elements [25].…”

Section: Introductionmentioning

confidence: 99%

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity

Moullin

Sabater‐Hernández

García-Corpas

et al. 2015

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity

Moullin

Sabater‐Hernández

García-Corpas

et al. 2015

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…To ensure comparability of pharmacylevel performance on quality indicators, differences in drug and patient characteristics must be accounted for so that pharmacists are not held accountable for performance differences due to dissimilarities in their pharmacy-practice population. Although such risk adjustment is a critical requirement for use of quality-of-care measures for comparative performance reporting, it has only recently been emphasized when comparing pharmacy-team level performance (82,83). As outcome measures are identified that are consistently influenced by the quality of pharmacists' care, confounders will require identification and pharmacy-team level results adjusted accordingly.…”

Section: Research Question 4: Figure 1 Points C Andd Analyzing the Detementioning

confidence: 99%

Community pharmacists’ quality-of-care metrics

Winslade¹

View full text Add to dashboard Cite

People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User Agreement:

show abstract

“…PQA provides no guidance on risk adjustment (Pharmacy Quality Alliance, 2015). Dharmarajan and colleagues found casemix adjustment significantly improves identification of high and low value pharmacies (Dharmarajan, Bentley, Banahan III, & West-Strum, 2014). PQS's own work has suggested a need for risk adjustment of quality metrics (Desai, Nau, Conklin, & Heaton, 2016).…”

Section: A5 Value Based Payment Models For Pharmacy: An Underexplomentioning

confidence: 99%

“…CCNC's method of attribution is not specified, but the use of non-prescription-related metrics suggests that patients are prospectively or retrospectively assigned to single pharmacies (Trygstad, 2015). A singlepharmacy attribution method was also used for a paper assessing risk adjustment methods for adherence metrics which retrospectively assigned patients a single pharmacy filling at least 75% of their prescriptions (Dharmarajan et al, 2014). Wellmark's high performing pharmacy network uses an attribution threshold of 50% (Mascardo, 2016).…”

Section: D21 Attributing Patients To Pharmaciesmentioning

confidence: 99%

“…To aggregate measures of process quality to a more usable number that potentially correlated with the pharmacy's underlying care-process quality, a single process quality score was created. Following the method used by Dharmarajan et al (2014) and Li, Cai, Glance, Spector, and Mukamel (2009) and described more fully in sections 3.e.3, 3.e.5 and 3.e.6, high quality pharmacy outliers for a given process metric received a score of +1 and low quality outliers received a score of -1. Scores were summed across the four quality metrics and the resulting Process Quality Score had a potential range from -4 to +4.…”

Section: D25 Quality Scoring For Pharmaciesmentioning

confidence: 99%

See 1 more Smart Citation

Assessing the relationship between pharmacy quality and healthcare cost for a commercially insured population

Urick¹

View full text Add to dashboard Cite

Background: In response to high cost and inadequate quality, the healthcare system is in the midst of a transition from paying for volume to paying for value. Billions of dollars could be saved through more effective medication use, and evidence supports the role of the community pharmacist in lowering healthcare cost and improving healthcare quality through medication optimization. Despite this, value-based payment models for community pharmacies are rare, and those that do exist have not been critically evaluated and implementation in a commercially insured population is rare. Objective: The first objective was to design and test a conceptual model of pharmacy value. The second objective was to evaluate variation in the value community pharmacies provide a commercial insurer by assessing the relationship between attributed patients' healthcare quality and cost. Methods: This study used prescription and medical claims data for 2012 and 2013 from a large commercial insurer in Iowa and South Dakota. Patients were attributed to the pharmacy filling the majority of their prescriptions. Pharmacies' weekly prescription volume and Sunday prescription filling behavior were used as structural measures of healthcare quality. Percent of days covered (PDC) metrics for beta-blockers, statins, renin-angiotensin system antagonists and non-insulin diabetes agents were used as process metrics. Pharmacies were excluded if the denominator for any PDC metric was less than 15. Outcome metrics consisted of a non-trauma, non-cancer, unplanned hospitalization rate and a non-trauma ED visit rate. Cost impact was categorized into pharmaceutical, medical, and total cost of care. High quality pharmacies with typical or low associated costs or low cost pharmacies with typical to high quality were identified as high value and vice versa for low value. All metrics were risk-adjusted using mixed effect models with a random pharmacy intercept. The ratio between observed and expected quality scores was used for v quality scoring. Quality outliers were identified by comparing the 95% CI around pharmacies' risk-adjusted scores to the all-pharmacy risk-adjusted score mean. A t-test was used to assess variation in pharmacy value. Results: There were 171 pharmacies and 74,581 patients eligible for scoring on all quality metrics. Mixed effects models observed a small but significant impact of pharmacy on process and outcome healthcare quality. No relationship between structures and processes, processes and outcomes was detected. Ten pharmacies were scored as high quality and nine as low quality. Similar numbers were identified for cost outliers, and significant variation in value was detected. Implications/conclusions: Results support the hypothesis that high and low value pharmacies exist. A well-designed value-based payment model could be used to create incentives for pharmacists to enhance care for commercially insured patients, but validation is needed to ensure that incentives are aligned appropriately. vi

show abstract

Measuring Pharmacy Performance in the Area of Medication Adherence: Addressing the Issue of Risk Adjustment

Cited by 10 publications

References 36 publications

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity

Development and testing of two implementation tools to measure components of professional pharmacy service fidelity

Community pharmacists’ quality-of-care metrics

Assessing the relationship between pharmacy quality and healthcare cost for a commercially insured population

Contact Info

Product

Resources

About