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OVERVIEW Safere Diawara, MPH Quality Management Coordinator


3 Why are we doing this work?
Increase in multiple chronic conditions Alignment with HRSA Core Measures ADEs leading cause of death and injury – IOM Report Aging population - polypharmacy Lack of integration of clinical pharmacy services Increasing numbers of Americans with multiple chronic health conditions. Use of medications is the most common approach for the treatment of chronic conditions whose associated costs and human burden continue to grow In alignment with HRSA Core Measures, specifically in Diabetes, Cardiovascular, and HIV screening ADEs are leading cause of death and injury in the US costing billions Aging population, more medications - polypharmacy IOM: To Err is Human Literature supports use of clinical pharmacy services to improve health outcomes, enhance patient safety and create cost savings – current lack of integration

4 Why a Patient Safety & Clinical Pharmacy Collaborative?
“The [Senate Appropriations] Committee further encourages HRSA to establish a pharmacy collaborative to identify and implement best practices, which may improve patient care by establishing the pharmacist as an integral part of a patient-centered, interprofessional health care team.” 2007 & 2008 Senate Appropriations Committee Reports Encourage Pharmacy Collaborative. FY 2007 and FY 2008 Senate Appropriations Committee Reports Collaboration with external and internal stakeholders Major pharmacy organizations, 340B Coalition members and others Contract with Mathmatica Policy Inc. FY 2008 Senate Appropriations Committee Report Program Management-…Committee commends HRSA for working with stakeholders to develop recommendations and implementt cost effective clinical pharmacy services to improve patient health outcomes as components of federally qualified health centers, rural hehospital programs, academic medical centers, Indian Health Service programs, Ryan White programs, and all HRSA supported programs in which medications play an integral part of patient care. The Committee looks forward to receiving a report of these activities. The Committee strongly encourages HRSA to continue to develop and implement cost effective clinical pharmacy programs in all aof the various safety net providers settings. The Committee further encourages HRSSA to establish a pharmacy collaborative to identify and implement best practices, which may improve patient care by establishing the pharmacist as an integral part of a patient-centered, interporfessional health care team.

5 Institute of Medicine Findings on Patient Safety and Errors
Medication Errors are Most Common Injure 1.5 Million People Annually Cost Billions Annually “…for every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.”


7 Patient Safety & Clinical Pharmacy Collaborative Goals
Improve Health Outcomes by implementing effective patient safety principles and clinical pharmacy services Improve Patient Safety Fewer errors, fewer injuries, less harm Increase High Quality, Cost-Effective Pharmacy Services Maximizing and enhancing medication use management

8 Emerging Aims Clinical Pharmacy Services and Patient Safety
More clinical pharmacy for complex patients More management of high risk medications Fewer drug-drug interactions Fewer potentially inappropriate medications Medication reconciliation for 100% of patients Healthcare organizations develop and sustain a culture of medication safety Drug-Drug Interaction: effects of one drug are altered by the administration of another drug Potentially Inappropriate Medications: example: especially drugs that are inappropriately prescribed to the elderly, like naproxen, amiodarone, long-acting benzodiazepines and anticholinergic antispasmodics which are some of the most common.

9 Value Proposition Organizations can achieve better health outcomes for patients through safer, integrated clinical pharmacy services.


11 What are clinical pharmacy services?
Patient-centered services that promote the appropriate selection and utilization of medications to optimize individualized therapeutic outcomes Provided by an inter-disciplinary healthcare team through individualized patient assessment and management Services best provided by a pharmacist or by another healthcare professional in collaboration with a pharmacist

12 What is the Patient Safety & Clinical Pharmacy Collaborative?
18 month rapid learning model that creates a community of learning, bringing together interdisciplinary teams from multiple types of organizations focused on improving health outcomes by focusing on improved patient safety and clinical pharmacy services. Collaborative learning is accomplished by using learning sessions, action periods, Web training and listservs to measure, report and track improvement. Led by an expert faculty poised to help test and implement successful practices.

13 Care Transitions and Handoffs
Hospital Inpatient Patient Multiple Conditions Hospital ED Primary Care Home(s) What are the constants? one example of a flow for a patient ... with diabetes (walk them through the steps) Specialist

14 Care Transitions and Handoffs
Hospital Inpatient Patient Multiple Conditions Hospital ED Primary Care Home(s) What are the constants? why are these conditions for a disaster? Pharmacy Services Specialist Conditions For A Disaster

15 Care Transitions and Handoffs
Patient Multiple Conditions Hospital Inpatient Patient Self- Management Hospital ED a solution to the hand off reality could be .... self-management and clinical pharmacy services. This is only one of many ways you could map this out. Primary Care Home(s) Pharmacy Services Clinical Pharmacy Services Specialist

16 Patient Safety Pharmacy Collaborative
Optimum Health Outcomes Integrated Patient Care So on the ground at the sites, this is what we want to see happen. A patient enters into the system where clinical pharmacy services are delivered as a major component of car. We will then measure the results and outcomes of that integrated care through optimization of health outcomes and limiting adverse events. So what is the value in this……System improvements in pharmacy services will improve outcomes and safety for your patients across a broad range of chronic conditions. …we’re ready to go beyond improvements one disease at a time! Integrated Clinical Pharmacy Services and Improved Patient Safety Lead to Better Patient Health Outcomes AND Chronic Disease serves as a marker for detecting improvement in the system Clinical Pharmacy Services No Adverse Events

17 Learning Collaborative Engine
Enroll Participants Select Topic Prework Identify Change Concepts Planning Group LS1 AP1 LS2 AP2 LS3 AP3 LS 4 LS4 PDSA=Plan, Do, Study, Act LS= Learning Session AP=Action Period Supports Listserv Site Visits & Filming Conference Calls Rapid Sharing Team Reporting Web site Leadership Coordinating Council Adapted from IHI Breakthrough Series Collaboratives 4 4 4

18 Patient Safety & Clinical Pharmacy Collaborative – Next Steps
Share the information with potential partners Engage with community partners Engage senior leaders in the vision Secure support for participation Review participation package on: Submit Team Participation Package

19 Patient Safety & Clinical Pharmacy Collaborative (PSPC)
Participation Requirements 19 19

20 State Based Organization Partners
State Primary Care Associations State Primary Care Offices State Offices of Rural Health State Hospital Associations State Pharmacy Associations State AIDS Directors Quality Improvement Organizations Foundations Institute for Healthcare Improvement (IHI) Campaign Nodes Health Center Network Leaders Area Health Education Centers Others Who Want to Help Enroll and Support Collaborative Teams

21 Who will join? Teams of providers from multiple caregiver organizations in a community who want to improve the quality and safety of care for a defined patient population they together serve: Health Centers Rural Health Clinics Critical Access Hospitals Disproportionate Share Hospitals HIV AIDS Clinics Others (inclusivity is encouraged) Examples of other possible team members include outpatient ambulatory care clinicians and leaders, HIV and Women’s Health Organizations, state and local health departments, social services, mental health, home care and other non-physician staff who participate as part of an extended primary healthcare team.

22 Key Benefits of Participation in the PSPC
It’s the Right Thing to Do for the Patients We Serve Safer More, Better Pharmacy Services Improved Health Outcomes Reduces/Manages Risk – and Risk is Increasing Builds on and Takes Prior Experience to a New Level Integrated Takes HRSA Collaborative Experiences to the Next Power

23 What will the teams do? Commit to Collaborative aims
Commit time and effort Designate consistent members to attend all 4 Learning Sessions and support travel Measure and track progress Share activities and results Align with team around continuity of care Bring their organizations’ senior leader(s) to Learning Sessions Commit to the overarching Aims of the Collaborative Commit time and effort to testing and adapting changes Attend all 4 Learning Sessions (some may be State or Regional) and pay for their travel Measure and track progress and share activities and results with their senior leaders and other teams Bring all organizations on a given team in alignment and action around continuity of care Bring their organizations’ senior leader(s) to a designated Learning Session


25 EVMS PSPC TEAM Working together to improve Services, Safety and
Quality of Care for all our consumers!

26 Basic Facts on the EVMS Patient Safety & Clinical Pharmacy Services Collaborative
Primary Health Care Home Organization: Eastern Virginia Medical School, Norfolk, Virginia Team Name: Eastern Virginia Medical School Patient Safety & Clinical Pharmacy Services Collaborative Motto: Communication, Collaboration and Commitment Team Leader: Judy Wessell, Nurse Practitioner The collaborative is composed of staff from EVMS, peer educator consultants, the Gloucester County Health Dept, and an independent PharmD.

27 Thanks to VDH for the financial and technical assistance to the Eastern’s EVMS PSPC team.

28 HRSA Five Strategies Leadership Commitment Measurable Improvement
Integrated Care Delivery Safe Medication Use System Patient Centered Care

29 PDSA-Worksheet for Testing Change
Aim: (overall goal you wish to achieve) Every goal will require multiple smaller tests of change Plan List the tasks needed to set up this test of change: Person responsible, When to be done, Where to be done Predict what will happen when the test is carried out Measures to determine if prediction succeeds Do Describe what actually happened when you ran the test Study Describe the measured results and how they compared to the predictions Act Describe what modifications to the plan will be made for the next cycle from what you learned

30 EVMS Change Package

31 Clinical Pharmacy Services
The following are core elements of CPS which patients are currently receiving at the Gloucester County care site: Patient counseling Preventive care programs (smoking cessation) Retrospective Drug Utilization Review (ADE/ADR) Medication Therapy Management (Med reconciliation, Triple HAART, hepatic/renal evaluation) Disease State Management (Viral Load/CD4, Lipid/metabolic evaluation) Prospective chart review (co-morbid disease)

32 EVMS PSPSC: Patient Flow Across Providers
Pharm D and RN Educator Pharmacy Access Medical Case Management at Gloucester Health Department Local P A T I E N T Mail Order ADAP EVMS HIV Treatment at Gloucester Health Department Oral Health EVMS Urgent HIV Care at Norfolk Social Case Mgt. and Ancillary Support Patient’s P.C.P. or Specialty Site Local Hospitals for Diagnostics and Treatment Sites of Clinical Pharmacy Services Local Service Providers Non-medical Sites

33 An example in improvements in health outcomes
Cohort: Entire Population of Focus Safety Measure: Establishment of, or collaborating with, a patient-centered health care home. Measure Improvement: The process of consultation with a patient’s PCP or other provider in order to do a medicine reconciliation establishes the need for, or number of, changes from baseline. Display: Electronic medical record medicine list from EVMS. Use: CPS will verify record at each encounter, thereby, Promoting patient health literacy and self care involvement Developing a protocol communication between participants in the healthcare process Establishing and maintaining responsive linkages between local service providers and the delivery of patient care -- addressing the unique needs of an HIV+ population.

Cindy Lewis, EVMS RN Educator Judy Wessell, EVMS Nurse Practitioner Tanya Kearney, Dir. AIDS Resource Center Fred Casey, Project Off. Ryan White Part B Allison Gray, RN Clinical Quality Coord. Dr. Virginia Walker Contract Pharm D Janet Hall Consumer, Ryan White Part B MOST OF OUR HAPPY FAMILY Pierre Diaz Consumer, Ryan White Part A Rick Hall , Health Counselor Three Rivers Health Dept.


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