©PPRNet 2014 NEW PROJECT Reducing ADEs from Anticoagulants, Diabetes Agents and Opioids in Primary Care

©PPRNet 2014 GOALS Present newly funded medication safety project Discuss opportunities for practice and patient involvement Plan your role in the project

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WHY? High priority medications “ADEs across inpatient and outpatient settings are common, clinically signficant, preventable and measurable” –Anticoagulants –Diabetes agents –Opioids

©PPRNet 2014 Focus on high priority medications “…address the prevention of harm, but also promote standardized and idealized practices and behaviors” Include patients as a vital part of research Target ambulatory care Advancing Patient Safety Implementation through Safe Medication Use Research (PA )

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TIMELINE June-July 2014 “Good” score Respond to criticisms January 25, 2014 Application submitted December 2013 – January 2014 Project planning Request letters of support November 2013 Funding Announcement posted

©PPRNet 2014 PROJECT GOALS 1)Clarify risk factors for ADEs from high priority medications through a literature review and translate them into a working set of clinical quality measures that can be implemented in primary care 2)Use a community engaged action (CEA) research approach to test the impact of a refined set of preventive strategies for ADEs on practice performance on ADE clinical quality measures

©PPRNet 2014 GOAL 1: DEVELOP ADE MEASURES Preliminary set of measures –Based on established risk factors –Include existing or proposed MU measures Existing Stage 2 MU measures Proposed Stage 3 MU measures Proposed by research team based on National Action Plan –Revise based on provider input during year 1

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk Factor Lack of safe prescribing and monitoring processes for new oral anticoagulants Example: Anticoagulants

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk FactorCQM Lack of safe prescribing and monitoring processes for new oral anticoagulants Patients on appropriate doses of new oral anticoagulants based on renal function Example: Anticoagulants

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk Factor Application of aggressive glycemic targets in high risk patients Example: Diabetes Agents

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk FactorCQM Application of aggressive glycemic targets in high risk patients Patients > 65 years with diabetes on sulfonylurea or insulin AND most recent A1C > 7% Patients with specific comorbidities* on sulfonylurea or insulin AND most recent A1C > 7% Example: Diabetes Agents

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk Factor Higher than recommended daily doses Example: Opioids

©PPRNet 2014 GOAL 1: PRELIMINARY MEASURES ADE Risk FactorCQM Higher than recommended daily doses Patients on recommended doses of long-term opioid therapy Example: Opioids

©PPRNet 2014 GOAL 1: MEASURE DEVELOPMENT ActivityTimeline Confirm participation of 24 practicesToday! Clarify ADE risk factorsOct 2014 Specify measuresDec 2014 Survey providers “Is this a useful measure of quality?” Open comments Early 2015

©PPRNet 2014 GOAL 2: TEST “COMMUNITY ENGAGED” APPROACH Practice community = patients or non-professional caregivers, clinical staff and providers Site visits and regular follow-up Purpose: –Academic detailing on ADE risk factors –Performance review and improvement planning –Practice-specific integration of strategies to prevent ADEs

©PPRNet 2014 YES, PATIENTS! Practice invites 9-12 patients or non- professional caregivers to participate –From PPRNet list of patients eligible for CQMs Ideal characteristics of “key informants” –Ability to communicate clearly –Interest in project goal –Willingness to participate in site visits –Together, represent diverse age groups, race/ethnicity, medications

©PPRNet 2014 Community Engaged Group (12 practices) Control Group (12 practices) Provider surveysXX Reports on ADE measuresXX Site visits with patient “key informants” X Regular follow-up via webinar/ X

©PPRNet 2014 WHAT IS REQUIRED OF PRACTICES? Open to all members! Submit PPRNet data extracts through Sept 2017 Complete two rounds of measure development survey Agree to invite patients to participate AND host 3 site visits if randomized to intervention

©PPRNet 2014 INCENTIVES TO PARTICIPATE Opportunity to define “meaningful” CQMs Facilitated PPRNet quality and safety improvement assistance Concrete example for PCMH “Patient Advisory Council” objective Financial incentives for practices ($1200 each + $800/intervention) and patient advisors ($25/activity)

©PPRNet 2014 LETTERS OF SUPPORT We received letters of support from 15 practices in attendance: Advanzed Health Care PLC Cayuga Family Medicine Dutter Hufford Daley MDs Family Medicine of Port Angeles Family Practice Associates, LLP Lovelace Family Medicine Northeast Iowa Medical Education Foundation Plymouth Family Physicians Quality Family Practice Ravalli Family Medicine Rio Grande Medicine Smoky Hill Family Medicine Residency Program Springfield Health Care Summit View Clinic The Internal Medicine and Pediatric Clinic of New Albany

©PPRNet 2014 IT’S NOT TOO LATE! Byron Center Family Medicine Chatuge Family Practice Clover Fork Clinic Diana Lozano, MD, PA Family Health Associates Fulton Family Health Associates Georgia Regents Family Medicine Center Good Samaritan Health Center of Cobb Hilliard Family Medicine Hugh D. Durrence, MD John A. Martin Primary Health Care Center Lake Lansing Family Practice Matthew White, MD Mt View Family Practice Natural Family Wellness New London Family Practice Robert E. Barnett, M.D. LLC Rio Grande Valley Adult and Internal Medicine Skyline Family Practice Sopris Medical Practice South Park Internal Medicine UT Health Systems

©PPRNet 2014 ARE YOU IN? Yes Yes, awaiting confirmation from the rest of my practice No because …

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EXTRA SLIDES

©PPRNet 2014 WHY? Adverse drug events are “injuries from medical intervention related to a drug” Preventable ADEs could have been avoided or mitigated by hightened monitoring or more optimal care management

©PPRNet 2014 PROJECT OVERVIEW

©PPRNet 2014