ADE Prevention and Care Coordination Integration

ADE Prevention and Care Coordination
Integration
Michael Crooks, PharmD, PCMH-CCE
GMCF
Darren M. Triller, PharmD
Atlantic Quality Innovation Network
Jim Turpin, Quality Improvement Consultant
TMF Quality Innovation Network
The CMS Healthcare Quality Conference
Baltimore, MD | December 2 – 4, 2014
Follow us on Twitter:
@QIOProgram
Tweet with our conference hashtag:
#QualityNet14
Medication Adherence:
The Foundation of Medication Safety
December 2, 2014
Michael Crooks, PharmD, PCMH-CCE
GMCF
Follow us on Twitter:
@QIOProgram
Tweet with our conference hashtag:
#QualityNet14
2
Dentist Appt. 1
3
Dentist Appt. 2
Case Study
Diabetes and Medication Adherence
4
►
66 YO Female: Diabetes, HTN, COPD, Gout, HLD
►
Meds:
Carvedilol BID
Hydrochorothizaide QD
Quinapril QD
Metformin TID
Actos QD
Glipizide BID
Spiriva QD
Advair BID
Albuterol Prn
Allopurinol QD
Indomethacin PRN
Hydrocodone/APAP
Prn
Atorvastatin QHS
Ezetimibe QD
Gemfibrozil BID
Prednisone Taper
5
6
Medication Adherence: Problems
►
75% of people do not take medicine as directed
►
1 out of 3 never fill their prescriptions
►
125,000 die every year due to non-adherence
►
1 in 3 medication related hospitalizations are due
to poor adherence
Source: Script Your Future. Consumer Infographic.
www.scriptyourfuture.org 11/12/2014
7
Medication Adherence: Solutions
8
►
Adherence Campaigns: Script Your Future
►
Assessment Tools: Merck Adherence Estimator,
CMS Star Ratings, PQA/EQuiPP
►
Pharmacy Practice: Medication Synchronization,
Medication Therapy Management
►
Patient Empowerment: Education/Rx
Counseling, Comprehensive Medication List,
Patient-Centered Care Planning
Medication Adherence: Helpful Links
9
►
ScriptYourFuture.org
►
TheFamilyCaregiver.org
►
PQAalliance.org
►
CMS.gov/Medicare/Prescription-Drug-Coverage/
PrescriptionDrugCovContra/MTM.html
►
APHAFoundation.org/appointment-based-model
►
NCPAnet.org/membership/benefits/preview-ofsimplify-my-meds-
MAKING HEALTH CARE BETTER
Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of
Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-GMCFQIN-D1-14-01
10
Anticoagulation
Communication at Discharge
(AC/DC)
Darren M. Triller, PharmD
Baltimore, MD
December 2, 2014
11
Anticoagulation: Current Events
12
The Poor Quality of Care is Shocking
13
[Insert Your Pun Here]
14
Anticoagulation Communication at Discharge
•
•
•
•
•
Define requisite information elements for ALL
Evaluate individual provider baseline performance
Identify opportunities for improvement
Rectify individual communication processes
Re-measure to demonstrate
improvement/sustainability at individual sites
• Establish high quality, “alternating current”
information exchange across settings
• Evaluate overall performance across community
• Outcomes (AC-related ADEs)
15
AC-DC Paper Tool
http://qio.ipro.org/drug-safety/drug-safety-resources
16
AC-DC Excel Tool
17
AC-DC Excel Performance Dashboard
18
19
20
Focus on Opioids in the
TMF Quality Innovation
Network
December 2, 2014
Presented by
Jim Turpin, Quality Improvement Consultant
TMF Quality Innovation Network
21
Challenges and Successes
Challenge: The recent October 6, 2014, Drug Enforcement
Agency ruling on reclassifying hydrocodone combinations as
a Schedule II controlled substance
 Some hospitals are reporting the new prescription forms
and refill requirements have resulted in some prescribing
physicians sending patients who are in pain to the
emergency room (ER) for their hydrocodone refills.
 The TMF Quality Innovation Network Quality Improvement
Organization (QIN-QIO) is working through this issue to
reduce these ER admissions for this root cause.
22
Challenges and Successes (cont.)
Challenge: A number of other recurrent challenges are
appearing in all communities and include:
 A fractured medication reconciliation system between
transitions of care.
 Physicians reporting that the medication list print outs from the
electronic health record/computerized physician order entry are
difficult to follow or in some cases unintelligible.
 Providers lack of reimbursement (or knowledge of how to get
reimbursed) for medication therapy management.
 A lack of transportation for patients to their provider for
medication refill or review.
 Patients who are unable to afford the copay for medication or
they have hit the “Donut Hole.”
23
Challenges and Successes (cont.)
Successes: To prevent readmissions and increase
medication adherence. Many hospitals before discharge
reported:
 Reviewing cost of medications with the patient and
changing from branded to generic script to ensure
adherence.
 Reviewing cost of medications with the patients and if they
are unable to purchase them, paying the out-of-pocket cost
of the medications for the patient. Their comments are that
the return on investment of paying for the medication
trumps a readmission penalty.
24
ADE Data from the TMF QIN-QIO & NCC
 Adverse drug event (ADE) measures are being developed
with the National Coordinating Center (NCC) in conjunction
with the TMF QIN-QIO.
 Currently, the TMF QIN-QIO is considering an ADE
measure that pairs national drug codes and evidencebased diagnoses for the three high-risk medications
(HRMs: anticoagulants, diabetic agents and opioids).
 The TMF QIN-QIO has held bi-weekly regional calls to
develop these measures and reports for our communities.
25
ADE Data from the TMF QIN-QIO & NCC
(cont.)
 ADE data reports (global ADE and three HRMs) will be
available through the secure data portal for our TMF QINQIO communities on the TMF QIN-QIO Learning and
Action Network (LAN) at:
http://www.tmfqin.org/Networks/Readmissions/State-andCommunity-Data
 These will include 30-day readmission reports by the three
HRMs and global ADE rates.
26
Integration Across Tasks in the Community
 During the TMF QIN-QIO’s recent regional community
recruitment meetings, recruited providers are:
 Familiarized with all of the tasks in the 11th SOW to show
congruence of effort.
 Directed to join the TMF QIN-QIO LAN at: www.tmfqin.org
for selecting task projects.
 Encouraged to visit the Home Health Quality Improvement
website for tools, resources and assistance at
www.homehealthquality.org
 Introduced to TMF QIN-QIO staff from other tasks (B.1, B.2,
D.1, etc.) to emphasize alignment of tasks and efforts.
27
Integration Across Tasks in the Community
(cont.)
 All providers/practitioners participate in an initial community needs
assessment during initial recruitment meetings to show commonality of
causes.
 Emphasis is placed on first doing a root cause analysis (RCA) for every
community as each one is unique.
 RCAs allow for teasing out multiple transition of care issues from
different provider types (e.g., hospital to home health to nursing home,
etc.)
This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under
contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do
not necessarily reflect CMS policy. 11SOW-QINQIO-C3.6-14-10
28

Download Report