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Medication Management Measures: NQF and Beyond

AHRQ's Annual Research Conference Panel Session September 16, 2009. 2. Medication Management Measures: NQF and Beyond. Background/ContextNQF ProcessSteering Committee ConsensusconclusionsconcernsIssues/Questions in Measuring Medication Management Quality. AHRQ's Annual Re

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Medication Management Measures: NQF and Beyond

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    1. AHRQ's Annual Research Conference Panel Session September 16, 2009 1 Medication Management Measures: NQF and Beyond Harold Alan Pincus, MD Professor and Vice Chair, Department of Psychiatry Associate Director, Irving Institute for Clinical and Translational Research Columbia University Director of Quality and Outcomes Research NewYork-Presbyterian Hospital Senior Scientist, RAND Corporation

    2. AHRQ's Annual Research Conference Panel Session September 16, 2009 2 Medication Management Measures: NQF and Beyond Background/Context NQF Process Steering Committee Consensus conclusions concerns Issues/Questions in Measuring Medication Management Quality

    3. AHRQ's Annual Research Conference Panel Session September 16, 2009 3 Linking Policy, Practice and Research

    4. AHRQ's Annual Research Conference Panel Session September 16, 2009 4 Policy Context Rising costs ? proportion of GDP Disparities in care regional, populations Growth in HIT stimulus, “meaningful use”, RHIO’s Translational science T1, T2, T3, T4/CER Alphabet soup of managers/regulators NCQA, NQF, Joint Commission, PBM, PQRI, NICE Quality and safety problems Crossing the Quality Chasm/IOM Health care reform?

    5. AHRQ's Annual Research Conference Panel Session September 16, 2009 5 To Err Is Human: Building A Safer Health System First Report Committee on Quality of Health Care in America To order: http://www.nap.edu

    6. AHRQ's Annual Research Conference Panel Session September 16, 2009 6 Crossing the Quality Chasm “Quality problems occur typically not because of failure of goodwill, knowledge, effort or resources devoted to health care, but because of fundamental shortcomings in the ways care is organized” The American health care delivery system is in need of fundamental change. The current care systems cannot do the job. Trying harder will not work: Changing systems of care will!

    7. AHRQ's Annual Research Conference Panel Session September 16, 2009 7 Image: Institute of Medicine Quality Chasm Series

    8. AHRQ's Annual Research Conference Panel Session September 16, 2009 8 Image: “Crossing the Quality Chasm”

    9. AHRQ's Annual Research Conference Panel Session September 16, 2009 9 Preparing for the Future Standardize Practice Elements Clinical assessment Interventions IT infrastructure Develop Guidelines Evidence-based medicine Shared decision making Measure Performance For each “6P” level Across silos Improve Performance Learn Reward Strengthen Evidence Base Evaluate effective strategies Translate from bench to bedside to community

    10. AHRQ's Annual Research Conference Panel Session September 16, 2009 10 Measure Performance “You can’t improve what you don’t measure” Develop quality metrics - structure - process - outcomes Across silos of data sources MCO/MBHO/PBM claims/EHR, etc. At each “P” level

    11. AHRQ's Annual Research Conference Panel Session September 16, 2009 11 Organizational Chart: “6P” Conceptual Framework

    12. AHRQ's Annual Research Conference Panel Session September 16, 2009 12 Strategies for Influencing Quality of Medication Care Guidelines/”Black Boxes” Provider Training/Education/CME Academic Detailing Pharmacist-based Interventions Preferred lists/Prior auth/Second opinion Certification/Accreditation/Licensure Provider Reminder System/Decision Support Patient Education/Reminders Quality Measurement/Improvement Public Reporting/Profiling/Feedback Financial Incentives/P4P

    13. AHRQ's Annual Research Conference Panel Session September 16, 2009 13 Medication Management 81% of adults take at least 1 med 90% of Medicare beneficiaries report taking prescription meds (nearly half use 5 or more) Between 14 and 23% of elderly receive inappropriate meds Up to 40% of patients do not take meds as prescribed Adverse drug events 2.5% of ER visits for unintentional injuries

    14. AHRQ's Annual Research Conference Panel Session September 16, 2009 14 NQF Process Open call for measures Augmented by lit review/National Quality Measures Clearinghouse Conditions for consideration public domain or IP agreement responsible entity to maintain public reporting and QI complete info (provisional if not tested) Criteria for evaluation- PH/Improvement importance- PH and improvement scientific acceptability-reliable/valid useability- decision making/6P’s feasibility- data available/burden Steering Committee- open consensus/interactive Member and public comment

    15. AHRQ's Annual Research Conference Panel Session September 16, 2009 15 Steering Committee Consensus Other NQF projects include medication management measures 35 submitted measures were considered Measure categories: prescribing/selection dispensing/adherence monitoring outcomes 19 measures recommended (7 time limited) 3 measures combined with other submitted measures Considerable interaction with measure developers to improve/modify measures Range of clinical topics spanned CAD, asthma, schizophrenia, COPD, INR monitoring, generic adherence/monitoring

    16. AHRQ's Annual Research Conference Panel Session September 16, 2009 16 Recommended Measures

    17. AHRQ's Annual Research Conference Panel Session September 16, 2009 17 Recommended Measures (cont’d)

    18. AHRQ's Annual Research Conference Panel Session September 16, 2009 18 Steering Committee Concerns Submitted (and recommended) measures do not represent full array needed to assess/improve quality Measures not linked or harmonized across multiple developers Single prescription for chronic diseases Multiple, conflicting, confusing ways to measure similar concepts (i.e. adherence) Limited testing of measures Need for continual updating Significant R and D needed for measures addressed/linked to outcomes, are patient-centered and cover a broader array of conditions, settings, populations

    19. AHRQ's Annual Research Conference Panel Session September 16, 2009 19 Proposed Standard Specifications for Adherence Measurement

    20. AHRQ's Annual Research Conference Panel Session September 16, 2009 20 Research Recommendations Adherence Measures appropriate use/reasons for non-adherence Plan of care measures expand patient/caregiver communication Medication review/reconciliation content/accountability COPD management lower risk patients Outpatient psychiatry adherence/monitoring/polypharmacy Migraine Use of technology bar coding/decision support/dose calc. Medication validation steps from order to patient/monitoring over time

    21. AHRQ's Annual Research Conference Panel Session September 16, 2009 21 Issues in Measuring Medication Management Quality Measurement v. Improvement Information lag/real time v. delayed Use of measures- POC v. external Accountability- pt/prescriber/pharmacist/plan Patient-centered measures- $/values/preferences Clinical exceptions v. “cookie cutter” medicine Adequacy of data bases include Dx/Indication on Rx Does measurement lead to improvement? MH HEDIS Does improvement lead to enhanced health status? Diabetes and ACCORD

    22. AHRQ's Annual Research Conference Panel Session September 16, 2009 22 The State of Health Care Quality 2006, NCQA There are, however, disturbing exceptions to this pattern of [overall health care quality] improvement. The quality of care for Americans with mental health problems remains as poor today as it was several years ago. Patients on antidepressant medication are about as likely to receive appropriate care today as they were in 1999. http://www.ncqa.org

    23. AHRQ's Annual Research Conference Panel Session September 16, 2009 23 Antidepressant Medication Management: Optimal Practitioner Contacts Trends, 1998-2005

    24. AHRQ's Annual Research Conference Panel Session September 16, 2009 24 Antidepressant Medication Management: Effective Continuation Phase Treatment Trends, 1998-2005

    25. AHRQ's Annual Research Conference Panel Session September 16, 2009 25 Image: “Crossing the Quality Chasm”

    26. AHRQ's Annual Research Conference Panel Session September 16, 2009 26 Image: San Francisco Bay Bridge

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