- Continuum of excellence

- Can be measured

- Used to evaluate health care providers

- Should increase probability of positive outcomes, decrease negative outcomes

Yes

- Know what they want, not what they need

- Measure by attention, wait time, attention given by providers

- Do they know enough about outcomes to accurately determine quality?

Donabedian - Structure, process, outcomes

- Quality has been previously measured through structure and process

- Quality not possible without structure and process

- This pertains to staff, resources, and physical set up of the pharmacy

- Number of pharmacists

- Counter space

- Credentials or license

- Square footage

- Medication reference books

- Medication stock

- counseling facilities

- Clinical guidelines or pathways

- % of prescriptions assessed for appropriateness

- % of patients counseled

Driving force behind pharm. care

- Morbidity

- Mortality

- Event rates

- Sx resolution

- ECHO model

Systems theory - Looks at entire system, define what you expect out of it, what are the inputs and outputs, what do we expect it to do?

Human Factor Principles - Checklists, DUR systems, Takes into account human beings do work, doing things by memory

Standardization - Milano cookies?!!?

Health care is lagging in quality, compare to airline industry

"Systematic monitoring and evaluation of various aspects of a project"

- Checking after the fact

- Problems are addressed after they occur

- Defect prevention

- Done to ensure quality

- May stop something and check to see if it's working right.  No guarantee that everything will be checked

- Continual improvement, no blame

- All workers interconnected, actioned planned to improve quality

- APhA resource is good example - Managing the patient centered pharmacy

Core elements: Plan after studying background, Design the methods, Measure the results, Assess the  conclusions, Improve the recommendations

- Assemble a team (interdisciplinary)

- Brainstorm by using things such as FMEA (Failure mode and effects analysis), Root cause analysis (inludes questions and actions plan, after the fact)

- Focus in on key area, make everyone aware of this focus

- Clarify that focus of importance is high cost, risk, volume, opportunity

- Overall goal is discovery, freq. of estimation, measuring a change. 

- Ensure data collection, data analysis, descriptive stats like charts

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- Joint Commission on Accreditation of Healthcare Organizations

- Wide focus of quality

- Hospital accredidation

- The ORYX initiative is the integration of outcomes into the accreditation process

- Need this accreditation to bill to medicare and medicaid and for research, and to be a teaching hospital.

- Standardized quality measurement and reporting

- Reviews and accredits all types of MHO's

- Largely process-oriented - quality management and improvement are most important. 

- Look at doctors and potential history of fraud

- Health Plan Employer Data and Information Set (Health care report card created by NCQA)

- So purchasers and employers can make informed decisions

- Formed by coalition of Fortune 500 companies?

- Create a market for quality

- Foundation for Accountability

- Evaluates quality from a consumer and purchaser perspective