Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) Session

1. Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) Session QualityNet Meeting Baltimore, MD December 13, 2012

2. Questions to Run On • How can your QIO support both beginning and advanced PSPC teams? • What tools and resources are available to help QIOs with the development of successful PSPC teams? • How can I encourage local team participation in PSPC events?

3. Intent of Today’s Call • Welcome QIOs to the PSPC 5.0 Collaborative Cohort • Celebrate and demonstrate successful QIO strategies • 3. Engage all QIOs to be active in our PSPC 5.0 Campaigns

4. Our Agenda Today we want to discuss three major topics: • The PSPC Campaigns for beginning teams and advanced PSPC teams • QIO Resources for a successful 5.0 • PSPC Team Optimization Strategies

5. How We Will Work Today • You will hear brief presentations on discussion topics • You will hear practical examples of QIOs that have been successful in these areas • Listen for what insights you heard • How can you incorporate shared strategies in your work? • What can you add to the QIO examples? • Be prepared to share your insights!

6. Celebrate Partnership with CMS and QIOs

7. PSPC 5.0 Today

8. PSPC 5.0 Today

9. PSPC 5.0 Goals Delivery System Transformation Actively Engaged Value Purchasing

10. Overview of Campaigns for PSPC 5.0

11. Two Parallel Campaigns Value Purchasing Campaign System Delivery Transformation • Team composition • Defining POF • Workflow for IMM • Using the Change Package • Health status & safety baselines • Tracking Performance Trends • Scale Up and Spread • Value Propositions • Leadership for Payment Arrangements • State reformation • Demonstrating impact & change

12. Engaging Teams in Both Campaigns Place Holder for the ID & OR QIO slides

13. Group Activity

14. Resources for a Successful PSPC 5.0

15. Partnership with RCC’s for Success

16. Partnership with RCC’s for Success • Monthly RCC calls, Topic Specific Calls!! • Topics meeting teams where they have needs • One on One calls • Setting individual teams up for success and contributing to the National Performance Story • Strategies to engage teams • Keeping the Main thing the Main thing!! • Saving lives!! Patients at the Center of PSPC • Going for the Gold

17. The Outcomes Sharing Site (OSS)

18. The Outcomes Sharing Site (OSS)

19. OSS http://www.healthcarecommunities.org/workarea/downloadasset.aspx?id=4294976577

20. Tools Assisting QIO’s in Supporting PSPC Teams • Communication Tools • RCC/QIO Quarterly Calls • Listservs • Roll Up Reports • Quick Start Toolkit • http://www.healthcarecommunities.org/workarea/downloadasset.aspx?id=4294976525 • PSPC 5.0 Change package • http://www.healthcarecommunities.org/Comm_DocsDetails.aspx?id=4294976502 • PSPC 5.0 Guide • http://www.healthcarecommunities.org/workarea/downloadasset.aspx?id=4294976500

21. QIO Resources for Success Jennifer Thomas, PharmD Manager Pharmacy Services Kim Harris-Salmone, PhD, MPA Vice President, Health Information Technology Health Services Advisory Group

22. Integrating the Patient Safety Clinical Pharmacy Services Collaborative (PSPC) Resources: Delmarva Foundation, the Quality Improvement Organizations for the District of Columbia and Maryland Jennifer Thomas, PharmD Manager Pharmacy Services

23. Objectives • Describe the Quality Improvement Organizations (QIOs) use of the resources available from Patient Safety Clinical Pharmacy Services Collaborative (PSPC) • Identify two examples of Team use of the tools to identify and define change process and improvement

24. PSPC Resources and QIO Contract Requirements • Recruitment – binder content • Technical Assistance: HC website (join PSPC, register for OSS, listserv, helpdesk), National & Regional Calls (Region 3) • Assessment • Learning Action Networks (LAN) • Measures • ADE/pADE – define • Health markers • A1c • INR - in range • INR - monthly • Documentation • Reporting - OSS

25. PSPC Team Recruitment

26. Resources – QIO Technical Assistance

27. ADE/pADE/Medication-Related Problems • PSPC defined (Dr. Chen – USC) ADE/pADE list • Medication-related problem • Safety (ADE/pADE) • Nonadherence and patient variables • Miscellaneous • NCC MERP classification • Severity rating

28. District of Columbia and Maryland PSPC Teams Discuss ADE/pADE Definition and Reporting

29. PSPC Gold Team – Process in Action

30. Team Meetings Review, Self Assessment

31. Monthly Team Assessment Scoring of 1 through 3 should be entered in one of the 5 Change Package strategies highlighted in yellow Y = yes, N= no & D = done should be entered into each of the change package concepts each month. Once the concept is implemented enter D and grey out the cell moving forward

32. PSPC Teams Activities and Recognition

33. PSPC Project – Team Recognition MPhA Journal Publication

34. Potential Adverse Drug EventsPCC – cont.

35. Potential ADEs and Anticoagulation Health Marker Status: Upper Chesapeake Health Anticoagulation Clinic

39. Contact information: Jennifer Thomas, PharmD thomasjen@dfmc.org 410-872-9698 This material was prepared by Delmarva Foundation for Medical Care and Delmarva Foundation of the District of Columbia, the Quality Improvement Organizations for Maryland and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (C M S), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect C M S policy. 10SO W-MD/DC-ADE-112712-232

40. Using PSPC Resources to Engage Teams and Monitor Teams’ Successes Kim Salamone, PhD, MPA Vice President, Health Information Technology Health Services Advisory Group Ksalamone@hsag.com

41. PSPC Resources • Outcomes Sharing Site (OSS) • ADE Access Database • On-site technical assistance • Workflow • Interventions • Reports • Partnership with REC • EHR template modification • Change packages • Gives teams ideas for interventions

42. HSAG’s interventions • AZ Team 1 – long-time clinical pharmacy program • EHR use for tracking • Also use ADE • Medicare hospital admissions/readmissions • AZ Team 2 – new pharmacist-run diabetes clinic • ADE Database most valuable resource • On-site technical assistance • Both AZ and CA teams • On-site technical assistance • OSS for progress • ADE database/EHR • Sharing of best practices

43. Monitor Success • Outcome Sharing Site (OSS) • Follow up with on-site visits • PDSA Status Updates • Team Development Level • Team Meeting Summaries/Next Steps • Tri-State Meetings at HSAG • Monitor • Problem solve

44. Barriers to Success • Technology • ADE database had to have certain OS • Groups’ IT departments restrictive • Turnover of team staff • Team time availability for the project • Team autonomy to implement PDSAs

45. Contact: Kim Salamone, PhD, MPA Vice President, Health Information Technology Health Services Advisory Group, Inc. Ksalamone@hsag.com (o) 602.801.6960 (m) 602.513.0761 This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Improvement Organization for Arizona, 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. AZ-10SOW-7.3-112710-01

46. Group Activity

47. PSPC Team Optimization

48. Our Collaborative Culture PSPC Aim: Inter-professional teams that improve the health outcomes and safety for high medication risk populations through patient-centered, cost effective medication management services align with quality national standards. Results: PSPC teams are transforming the primary healthcare delivery system by establishing effective interdisciplinary teams of care providers and integrating clinical pharmacy services into patient-centered, health home. Future: PSPC started its fifth year with a goal to ore than double the number of participating teams and communities to be part of the national movement to systematically transform the way health care is being delivered.

49. Using QIO’s to Create Successful Teams • Partnering with PSPC Faculty to Provide Team Support • Embracing the PSPC Collaborative Culture • Technical Support at the local level • One on One Support for Team • Site Visits – Hands On Support! • Personal Relationships with Team • Joining with Teams in Celebrating Successes

50. Modeling Successful QIO Support New Mexico Albuquerque MTM Collaborative and Walgreens Wondercats, both from NM, and QIO partner, Health Insight New Mexico, who collaborated on the journal article; Development and Dissemination of a Statewide System to Minimize Use of Potentially Inappropriate Medications. Walgreens Wondercats team member, Amy Bachyrycz, Pharm D, Albuquerque MTM Collaborative team member Melanie Dodd, Pharm D, and Health Insight New Mexico team partner, Galina Priloutskava, PhD, MBA, CHCA, authored the article discussing the Potentially Inappropriate Medications (PIMs) project in New Mexico in the most recent volume of Medical Care. Texas: • Implementing local collaborative teams of clinics, hospitals, pharmacies and nursing homes to participate in national collaborative learning sessions North Carolina: • A recent issue of the Washington Business Journal featured an article on Walgreen's pharmacists and their involvement with integrated medication management services related to hospital readmissions.  The article aligns nicely with the efforts being made by PSPC teams and emphasizes the impact these services have on the health care system.  The article also refers to PSPC team, Safe Med, from Winston-Salem, NC, led by Novant Medical Group, and their utilization of pharmacists to perform medication management services to patients. Oregon: In an press release from the Oregon Patient Safety Commission in March of this year, two PSPC teams were honored for their leadership in Patient Safety. Quote from the Ceremony: • When health care Organizations are transparent about adverse events, they are helping to create an environment that prioritizes patient safety. “Adverse event” is a term used to describe unintended harm to a patient as a result of medical care. 2 of the PSPC teams in Oregon were recognized in an awards ceremony as leaders in the states Patient Safety Reporting Program. • “These organizations are among the best of the best when it comes to patient safety reporting in Oregon, said Beth Higgins, executive director of the Oregon Patient Safety Commission. “To be clear, this doesn’t mean these organizations have more adverse events than others in Oregon. It means they are the most diligent when it comes to reporting. Every health care organization experiences adverse events. These teams were acknowledged for were their responsiveness to adverse events by learning what happened and working to prevent the event from happening again.” Read Article<Walgreen Pilot Cuts Hospital Readmission