HRSAs Bold National Patient Safety Clinical Pharmacy Services Collaborative; Opportunities for SORHs, Rural Hospitals

1. 1 HRSA's Bold National Patient Safety & Clinical Pharmacy Services Collaborative; Opportunities for SORHs, Rural Hospitals and their Partners Presenters: Denise H. Geolot, Ph.D., R.N. Director, Center for Quality Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Jimmy Mitchell, R.Ph., MPH, MS Director, Office of Pharmacy Affairs HHS, HRSA

2. 2 Presentation Purposes Provide High Level Briefing on Plans for HRSA Collaborative on Patient Safety and Pharmacy Share Data on Growth of Pharmacy Services Discuss Opportunities for SORHs, Rural Hospitals and their partners

3. 3 Some Key Questions How safe are HRSA-funded programs? What can we do to increase the quality and safety of these programs, especially in growth areas like medication management and pharmacy services? What are the emerging plans for making improvements? What are the benefits to the rural community and others for becoming involved in this work?

4. 4 Background: Institute of Medicine on Patient Safety 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.� Stress that this is an outpatient patient safety pharmacy services collaborative. Stress that this is an outpatient patient safety pharmacy services collaborative.

5. 5 HRSA & Administrator Duke�s Vision HRSA programs become the best and safest delivery systems in the United States HRSA program grantees and their safety net partners lead in creating a culture of clinical effectiveness and patient safety for the nation

6. 6 HRSA Pharmacy Programs Pharmacy services in HRSA programs & safety-net partners are growing rapidly $5,000,000,000

7. 7 First quarter FY 2006 - 12,469 covered entities currently participating in the 340B Drug Pricing Program. The program has grown more than 50 percent since January 2000 and a 4.7 percent growth since January 2005. First quarter FY 2006 - 12,469 covered entities currently participating in the 340B Drug Pricing Program. The program has grown more than 50 percent since January 2000 and a 4.7 percent growth since January 2005.

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9. 9 FY 2007 & 2008 Senate Appropriations Committee Reports Encourage HRSA Pharmacy Collaborative Implementation: �The 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.� 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. 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.

10. 10 What are Clinical Pharmacy Services? Patient-centered services that promote the appropriate selection and utilization of medications to optimize individualized therapeutic outcomes. Clinical pharmacy services are provided by an inter-disciplinary professional health care team through individualized patient assessment and management.

11. 11 The Patient Safety & Clinical Pharmacy Services Collaborative A synthesis of HRSA�s quality agenda and integrated programs designed for clinical effectiveness

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13. 13 We are now learning that pharmacy is critical and that pharmacy touches all services within the continuum of care. Clinical pharmacy services can be used as a lens to view integrated patient care services and is clearly a marker of quality, patient-centered care. We are now learning that pharmacy is critical and that pharmacy touches all services within the continuum of care. Clinical pharmacy services can be used as a lens to view integrated patient care services and is clearly a marker of quality, patient-centered care.

14. 14 The overlap also gives us the backbone of the PSPC. We are looking for leading practices in these areas and building these practices around our team. The overlap also gives us the backbone of the PSPC. We are looking for leading practices in these areas and building these practices around our team.

15. 15 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 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.

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17. 17  Phase 1: Study & Capability Development October, 2007 to April, 2008 Phase 2: Implementation, Action & Results May, 2008 to October, 2009

18. 18 Collaborative Game Plan So this is why we are here today: we want to 1. enroll national partners committed to patient safety and clinical effectiveness Create a knowledge package or Change Package that will identify leading practice models from HRSA funded entities. We have a time in the field now collecting this information. Align with existing standards of safety and health outcomes set by other organizations. We will use and synthesize things already invented. Use the collaborative action learning model as a proven method to replicate leading practices into safety net organizations and across the continuum of care. So this is why we are here today: we want to 1. enroll national partners committed to patient safety and clinical effectiveness Create a knowledge package or Change Package that will identify leading practice models from HRSA funded entities. We have a time in the field now collecting this information. Align with existing standards of safety and health outcomes set by other organizations. We will use and synthesize things already invented. Use the collaborative action learning model as a proven method to replicate leading practices into safety net organizations and across the continuum of care.

19. 19 What is a Change Package? Menu of Promising Action Items for Testing and Adapting for Use by Teams in Their Home Settings How are we going to do this? A menu of recipesHow are we going to do this? A menu of recipes

20. 20 I�d like to comment on these existing standards exemplified by the National Quality Forum. Using the National Quality Forum (NQF) Safe Practices for Better Healthcare: 2006 Update� as the foundation for collaborative, CQ will focus on 3 of the 7 key areas.I�d like to comment on these existing standards exemplified by the National Quality Forum. Using the National Quality Forum (NQF) Safe Practices for Better Healthcare: 2006 Update� as the foundation for collaborative, CQ will focus on 3 of the 7 key areas.

21. 21 Increasing Organ Donation in USAJan 1999 � Apr 2007 (Monthly) This Collaborative Method is exciting because we GET RESULTS and it is a PROVEN METHOD!! We have experience with our healthcare disparities collaborative and this Organ Donation Breakthrough Collaborative. We have systematically increase performance of organ donation in 3 years time. Just image if this was patient safety and clinical pharmacy and the impact we could have!!!!This Collaborative Method is exciting because we GET RESULTS and it is a PROVEN METHOD!! We have experience with our healthcare disparities collaborative and this Organ Donation Breakthrough Collaborative. We have systematically increase performance of organ donation in 3 years time. Just image if this was patient safety and clinical pharmacy and the impact we could have!!!!

22. Our Collaborative Process

23. Our Collaborative Process

24. Our Collaborative Process Teams get a lot of support through the process so that the learning sessions and action periods are productive. The support for this Collaborative is IN THIS ROOM as you make up the Leadership Coordinating Council. You will be hearing more about the role shortly.Teams get a lot of support through the process so that the learning sessions and action periods are productive. The support for this Collaborative is IN THIS ROOM as you make up the Leadership Coordinating Council. You will be hearing more about the role shortly.

25. 25 Milestones 30 Site Visits by March = Leading Practices Expert Panel in April = Change Package + Faculty State Based Organizations Leadership Meeting in D.C., May 1, 2008 First Learning Session in August, 2008 Fourth and Final Learning Session in December, 2009

26. 26  Kaiser Permanente in CO Baylor & Parkland in Dallas DFD Russell Medical Center, ME VA System Northland Hospital, Fairview System, MN El Rio Health Center in Tucson Westside Health Center in Minneapolis Harris County Hospital District, Houston, TX Paynesville Area Health Care System, MN Missouri Medicaid USC & Associated Health Centers, CA Northern Colorado Medical Center Southeast Arizona Medical Center Yuma Hospital District, CO AND MORE�������� These folks are getting the results we are after. This is breakthrough stuff�the kind of thing that shows up on the front of a newspaper! (next slide). Both Paul Moore from NRHA and Rich Marquez from the SORH in Denver have been involved with us during our debriefing sessions held after a cluster of sites visits that shape our Change Package. They have brought a great rural perspective to the table.These folks are getting the results we are after. This is breakthrough stuff�the kind of thing that shows up on the front of a newspaper! (next slide). Both Paul Moore from NRHA and Rich Marquez from the SORH in Denver have been involved with us during our debriefing sessions held after a cluster of sites visits that shape our Change Package. They have brought a great rural perspective to the table.

27. 27 Types of Facilities Visited

28. 28 Characteristics of Participating Organizations (N=22)

29. 29 Program gives pharmacists more clout in patient care These are two sites that work directly with HRSA.These are two sites that work directly with HRSA.

30. 30 DFD Russell Medical Center, Maine: A Nursing Model This is a grant funded project developed by DFD Russell Medical Center. The Steering Committee meets monthly and consists of Execs from all collaborators, patient assistance coordinators, RN, and social worker. RN receives clinical support and protocol approval from Medical Directors at both locations. RN consults with local pharmacists as needed regarding interactions and dosing. Laurie Kane-Lewis and Reginald Albert presented for us as a high performer at the Texas Medical Institute of Technology event in Orlando. Laurie Kane-Lewis and Reginald Albert presented for us as a high performer at the Texas Medical Institute of Technology event in Orlando.

31. 31 Examples of Health Outcomes Demonstrated reductions in BP 53 year old female 140/86 to 130/80 65 year old male 160/102 to 126/82 75 year old male 178/98 to 135/70 Demonstrated reductions in HbA1C levels 81 year old male 7.8 to 6.8 65 year old male 8.2 to 7.5 59 year old female 6.8 to 6.2 Hospitalization Reductions: $36,000 (1st year data) Total Savings to Health Care System: $44,500 (1st year data)

32. 32 Why HRSA Needs Rural Safety Net Participation Large urban models of care aren�t always applicable to small rural Small rural hospitals have proven they are interested, willing and capable of measuring and improving quality Replicable rural models of patient safety pharmacy initiatives are needed Rural has the potential to demonstrate �Best Practices� in improving safety in prescribing medicines and delivering quality health care to elderly 2nd bullet: Results from the 8th Scope of work (SOW) show that the percentage of CAHs who submitted data to Hospital Compare on at least one measure increased by 25% (from 53% to 78%) in two years In addition, according to a 2007 survey of CAHs done by the University of Minnesota, medication safety initiatives were the most frequently (22%) sited as the most important quality improvement initiative underway at their hospital. 3rd bullet�you will hear shortly about two patient safety initiatives from rural pharmacists 4th bullet The following facts are known about the elderly, especially those who live in rural: Research tells us that rural populations are disproportionately elderly with 25% of the nation�s elderly living in rural America. Rural seniors tend to be poorer and sicker. Elderly, in general, have more chronic diseases and thus are subject to over-prescribing. Thus, rural elderly can best benefit from clinical pharmacy services.2nd bullet: Results from the 8th Scope of work (SOW) show that the percentage of CAHs who submitted data to Hospital Compare on at least one measure increased by 25% (from 53% to 78%) in two years In addition, according to a 2007 survey of CAHs done by the University of Minnesota, medication safety initiatives were the most frequently (22%) sited as the most important quality improvement initiative underway at their hospital. 3rd bullet�you will hear shortly about two patient safety initiatives from rural pharmacists 4th bullet The following facts are known about the elderly, especially those who live in rural: Research tells us that rural populations are disproportionately elderly with 25% of the nation�s elderly living in rural America. Rural seniors tend to be poorer and sicker. Elderly, in general, have more chronic diseases and thus are subject to over-prescribing. Thus, rural elderly can best benefit from clinical pharmacy services.

33. 33 State Leadership & Partnering Day Hear a Top-to-Bottom, In-Depth Overview of the Collab Prepare to Recruit, Enroll, and Lead Local Teams Advance Input, Ideas, Offers and Actions to Make This a Spectacular Success Get Ready to Facilitate and Team Meet With National Experts, Faculty, National Organization Leaders, High Performers and Government Officials Involved in Implementation of the PSPC Prepare for 1st PSPC National Learning Session in August 13 -15, 2008 in Washington, DC Save the Date � May 1, 2008!! HRSA Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) Leadership and Planning Event: State and Local Organizations �Getting Ready to Team with HRSA on the Leadership of this Collaborative� Event Purposes HRSA Patient Safety and Pharmacy Collaborative (PSPC) Leadership and Planning Event: State and Local Organizations �Getting Ready to Team with HRSA on the Leadership of this Collaborative� Who Should Attend Organizations and people willing to: Commit to Ambitious Aims on Patient Safety and Clinical Pharmacy Services Convene Cross-Organizational Teams of Provider Organizations including: Health Centers DSH Hospitals Critical Access Hospitals HIV AIDS Programs Pharmacies & others Secure Funding for Teams to Travel to and Participate in Learning Sessions Support and Sustain the Momentum of Local Provider Teams Over an Anticipated 16-18 Month Improvement Process Work Together with Other Committed State and Local Leadership Organizations to Support Provider Teams in their Collaborative work Build Coalitions to Enable Sharing Between the Travel Team and the Home Team More� Anticipated State and Local Leadership Organizations Convening on May 1 State Primary Care Associations Logistics: State Hospital Associations May 1, 2008, 8:00 AM to 5:00 PM State Offices of Rural Health No Conference Registration Fee Local or Sub-State Conversion Foundations Doubletree Crystal City, Virginia State Primary Care Offices Pentagon City Metro (Blue/Yellow Lines) State Pharmacy Associations Participants Fund Their Own Travel Quality Improvement Organizations (QIOs) More details to follow� Others� See: http://www Save the Date � May 1, 2008!! HRSA Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) Leadership and Planning Event: State and Local Organizations �Getting Ready to Team with HRSA on the Leadership of this Collaborative� Event Purposes HRSA Patient Safety and Pharmacy Collaborative (PSPC) Leadership and Planning Event: State and Local Organizations �Getting Ready to Team with HRSA on the Leadership of this Collaborative� Who Should Attend Organizations and people willing to: Commit to Ambitious Aims on Patient Safety and Clinical Pharmacy Services Convene Cross-Organizational Teams of Provider Organizations including: Health Centers DSH Hospitals Critical Access Hospitals HIV AIDS Programs Pharmacies & others Secure Funding for Teams to Travel to and Participate in Learning Sessions Support and Sustain the Momentum of Local Provider Teams Over an Anticipated 16-18 Month Improvement Process Work Together with Other Committed State and Local Leadership Organizations to Support Provider Teams in their Collaborative work Build Coalitions to Enable Sharing Between the Travel Team and the Home Team More� Anticipated State and Local Leadership Organizations Convening on May 1 State Primary Care Associations Logistics: State Hospital Associations May 1, 2008, 8:00 AM to 5:00 PM State Offices of Rural Health No Conference Registration Fee Local or Sub-State Conversion Foundations Doubletree Crystal City, Virginia State Primary Care Offices Pentagon City Metro (Blue/Yellow Lines) State Pharmacy Associations Participants Fund Their Own Travel Quality Improvement Organizations (QIOs) More details to follow� Others� See: http://www

34. 34 Next Steps Begin recruiting rural health care organizations (RHCs, hospital outpatient clinics) Speak with potential state partners (QIOs, PCAs, PCOs, SHAs, etc) Sign up for the e-newsletter at the website. www.hrsa.gov/patientsafety patientsafety@hrsa.gov Participate in the May 1st State Leadership & Partnering Day RHC= Rural Health Clinics QIO= Quality Improvement Organizations SHA= State Hospital AssociationsRHC= Rural Health Clinics QIO= Quality Improvement Organizations SHA= State Hospital Associations

35. 35 Join Us In This Exciting Work! For more information, contact Nancy Egbert: negbert@hrsa.gov 301-443-0614 IHI Breakthrough Series White Paper: http://www.ihi.org/IHI/Results/WhitePapers/ TheBreakthroughSeriesIHIsCollaborative ModelforAchieving+BreakthroughImprovement.htm