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					  HRSA's Patient Safety & Clinical
 Pharmacy Services Collaborative:
An Update on this Bold National Effort

             June 25, 2008
        BPHC All-Grantee Meeting

Preparation for Team Submission of Participation Package



                                                       1
                   Overview
 Sue Sheridan Video: Call to Action

 Overview of the Patient Safety and Clinical Pharmacy
  Services Collaborative (PSPC):
   Denise Geolot, Director, HRSA Center for Quality
   Jimmy Mitchell, Director, Office of Pharmacy Affairs

 How will the PSPC work?
   Krista Scardina, Office of Pharmacy Affairs
   Rebecca Hines, Office of Planning and Evaluation
   Ahmed Calvo, Center for Quality

                                                       2
 Questions We Are Running On
What can local community organizations do to align with,
benefit from, and support this work?

How can HRSA Grantees and other organizations partner
with HRSA, national organizations, and state organizations
in leading this work?

What opportunities are there for further leadership and
involvement down the road in this collaborative?


                                                       3
  Operational Key Question
      for this Session

What can each of us do to help enroll
local community teams into the Patient
Safety and Clinical Pharmacy Services
Collaborative (PSPC) by July 1, 2008?


                                    4
 Why a Patient Safety & Clinical
   Pharmacy Collaborative?
• HRSA is committed to supporting programs to
  provide the best and safest care in the Nation
• HRSA has supported multiple Learning
  Collaboratives and has documented
  improvements gained through these rapid
  improvement methodologies
• Pharmacy services in HRSA programs &
  safety-net partners are growing rapidly

                                                   5
    Why are we doing this work?
• Increase in multiple chronic conditions

• Alignment with HRSA Core Measures

• ADEs leading cause of death and injury – IOM Report

• Aging population & polypharmacy

• Lack of integration of clinical pharmacy services

• Lack of coordination for patient transitions

                                                      6
Institute of Medicine Findings on
    Patient Safety and Errors
           • 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.”


                                                  7
  HRSA Pharmacy Programs

• Pharmacy services in HRSA programs
  & safety-net partners are growing
  rapidly


          $5,000,000,000

                                       8
Growth of Section 340B
 Covered Entity Sites




                         9
       HRSA Core Measures
• Prenatal First Trimester Care
• Cancer Screening
    • Breast Cancer       • Cervical Cancer
    • Colorectal Cancer
•   Diabetes- A1C
•   Immunizations
•   Cardiovascular- Hypertension
•   HIV Prenatal Screening Test
                                              10
            Patient Safety & Clinical
          Pharmacy Collaborative Goals
•    Improve Health Outcomes by focusing on implementing
     effective patient safety principles and clinical pharmacy
     services

•    Improve Patient Safety
    – Increased Compliance w/ NQF Guidelines
    – Fewer Errors, Fewer Injuries, Less Harm
    – Possible Reductions in Size & Number of Tort Claims

•    Increase High Quality, Cost-Effective Pharmacy Services


                                                                 11
             What are
   Clinical Pharmacy Services?
• Patient-centered services that promote the appropriate
  selection and utilization of medications to optimize
  individualized therapeutic outcomes

• Provided by an inter-disciplinary healthcare team
  through individualized patient assessment and
  management

• Services best provided by a pharmacist or by another
  healthcare professional in collaboration with a
  pharmacist

                                                      12
   Patient Safety Pharmacy Collaborative

Patient
                             Optimum
                              Health
     Integrated              Outcomes
    Patient Care

      Clinical
     Pharmacy                   No
      Services                Adverse
                              Events

                                        13
     Patient Safety and Clinical
Pharmacy Services Collaborative




                Pharmacy
                 Services
  Integrated     Clinical
 Patient Care               QUALITY
   Services




                                      14
              PSPC Game Plan
• Partner with state and national organizations to
  support teams

• Create knowledge package

• Align aims, practices and measures with existing
  guidelines

• Use “collaborative action learning model”


                                                     15
    Our Collaborative Process
 Select       Enroll Teams
 Topics
               LS 1: August 14–15, 2008
Study High
Performers
                Action Period

 Create         LS 2: Early Dec. 2008
Change
Package         Action Period

                LS 3: April, 2009
 Identify
 Faculty             Action Period

                    LS 4: Fall 2009
             Key Players
• HRSA Leadership, Bureaus and Offices
• Faculty Leader/Practitioners and HRSA Team
• Leadership Coordinating Council of National Partner
  Organizations
• State-Based Organizations

…all supporting:

Frontline Caregivers and Administrators on
  Collaborative Teams
                                                    17
Leadership Coordinating Council
National organizations who care about patient
 safety, pharmacy and/or healthcare for the
 underserved….

…who are meeting and teaming to figure out
 what each of them can do to help Collaborative
 Teams to succeed.


                                                18
     Who are some of our
  emerging national partners?
ASHP          CMS             AHRQ
APhA          NACDS           Joint Commission
NRHA          IHI             Heinz Foundation
ANA           ISMP            NACHC
USP           PQA             ACU
FDA           CDC             AANP
Apexus/Prime Vendor Program   NASTAD
                   …and Many Others
                                             19
     Group Discussion and
         Processing
• What benefits does the PSPC
  create for your organization?

• What excites you about this
  effort?

                                  20
The Change Package




                     21
What do we do with all of our learning?

 What are the leading practices being
  used by high performing providers?

We bring together common themes in a
            Change Package



                                          22
  What is a Change Package?


Menu of Promising Action Items for
 Testing and Adapting for Use by
 Teams in Their Home Settings




                                     23
 What’s In a Change Package?
Strategies
  Plans for Achieving an End: System-Wide Improvement

Change Concepts
  Approaches Found to Be Useful in Developing Specific Ideas
  for Changes That Lead to an Improvement

Action Steps
  Specific Ideas to Implement Each Change Concept




                                                           24
  What Forms the Basis for the
       Change Package?

• Existing Research & Literature
• Leading Practices of High Performers
• Expert Panel
• Experiences of Collaborative Teams


                                         25
    Key Framing Questions
What are the successful practices that high
performing providers are using?

What do they look like in practice?

Who can articulate and project these practices
with clarity and power?


                                              26
     Strategies: What We’ve Learned
• Leadership Commitment:
  Develop organizational relationships that promote safe medication-use
  systems and optimal health outcomes
• Measurable Improvement:
  Achieve change using the value and power of data- driven improvements
• Integrated Care Delivery:
  Build an integrated health care system across providers and settings that
  produces safety and optimal health outcomes
• Safe Medication Use Systems:
  Develop and operate by safe medication-use practices
• Patient-Centered Care:
  Build a patient-centered medication-use system
                                                                         27
                          Strategy
                     Integrated Care Delivery

                    Change Concept
      Develop an integrated multi-professional care team
           that includes clinical pharmacy services
                       Action Items
• Establish trust and good communication among the participating
  providers by creating a standard protocol for collaborative
  practice agreements for clinical pharmacy services within and
  across organizations

• Promote internal collaborations to build teamwork among nurses,
  physicians, pharmacists, and other providers
                                                              28
    The Work of the Collaborative
• Create Expectation That Each Team Begins by
  Addressing a Change Concept Under Each Strategy

• Use the Improvement Model (Plan/Do/Study/Act) to
  test specific actions in their environment =

      Action Period Between Learning Sessions


                                                29
   High-Performer Outcomes
INR, Percent at goal              24.6 %      64.7 %
A1C, Number at goal                22           114
Reduction in A1C                              2.54%
Total visits/Avg visits per day               1492/16
Interventions                                  5964
Adverse drug events caught                 1 every 2 days
Major bleeds /clots                              0
ER visit reductions                            18%
Hospital admissions reductions                 36%
Cost savings                                > 1million
                                                            30
Dimensions of the Change Package
 •       Strategies/Change Concepts/Action Items

 •       Major Locus of Change:
           A coalition of providers that joins the Collaborative
           as a Team


 •       Introduced and led by a faculty of their peers
     –     Drawn from the field
     –     Articulate leading practices that get results


                                                                   31
          What’s Next
• Enroll teams in the PSPC – Due
  July 1, 2008 (11:59 pm EDT)
• Pre-Work starts of July 15, 2008 (two calls
  tentatively planned for July 22 and July 30)

• First Learning Session - August 14 - 15, 2008
  (Gaylord Hotel, Washington DC Metro Area)

                                                  32
                Who will join?
Teams of providers from multiple local caregiver
organizations in a community who want to improve the
quality and safety of care for a defined patient
population they together serve:
  •Health Centers
  •Rural Health Clinics
  •Critical Access Hospitals
  •Disproportionate Share Hospitals
  •Community Pharmacies
  •HIV AIDS Clinics
  •Others (inclusivity is encouraged)             33
    Teams of Providers like…..
•   Clinical pharmacists
•   Nurses
•   Doctors
•   Other primary care clinicians
•   QI staff
•   Administrators
•   Senior Leaders

                                    34
 Team Configuration Examples
• CHC + Disproportionate Share Hospital + Rural Health
  Clinic + Community Pharmacy

• HIV Clinic + Critical Access Hospital + Women’s Health
  Clinic

• Multiple CHCs + Disproportionate Share Hospital and
  their associated clinics

• Rural Health Clinic + Hospital + School/College of
  Pharmacy
                                                       35
Team Configuration Examples



      Many Others


                          36
Care Transitions and Handoffs
                Hospital Inpatient
  Patient
  Multiple
  Conditions     Hospital ED


                Primary Care Home(s)


                        Specialist


                                       37
Care Transitions and Handoffs
                 Hospital In Patient
  Patient
  Multiple
  Conditions      Hospital ED


                 Primary Care Home(s)


     Pharmacy            Specialist
      Services

                                        38
Care Transitions and Handoffs
                  Hospital In Patient
  Patient
  Multiple
  Conditions       Hospital ED
     Conditions
       For A      Primary Care Home(s)
      Disaster

     Pharmacy             Specialist
      Services

                                         39
    Care Transitions and Handoffs
            Patient
                            Hospital In Patient
            Multiple
            Conditions

                             Hospital ED
            Patient Self-
            Management
                            Primary Care Home(s)
Pharmacy
 Services       Clinical
                                    Specialist
               Pharmacy
                Services
                                                  40
Target patient populations that have
the following high risk
characteristics:
  – One or more chronic conditions
  – Encounters with multiple service providers where
    prescriptions can be written
  – Use of high risk medications (e.g., warfarin and
    insulin)
  – Use of multiple medications
  – Poor patient medication control and self-
    management or low health literacy

                                                       41
         What will the teams do?
1. Commit to Collaborative aims
2. Commit time and effort
3. Designate consistent members to attend all 4 Learning Sessions and
   support travel
4. Measure and track progress
5. Share activities and results
6. Align with team around continuity of care
7. Bring their organizations’ senior leader(s) to Learning Session #2



                                                                  42
Timelines for Participation

– Released May 15th

– Deadline to submit materials: July 1st

– Team prework begins July 15th

– First Learning Session: August 14 – 15 in
  the Gaylord Hotel, Washington, DC Area

                                              43
      Questions to Run On
What are the benefits to those who join the
 Patient Safety and Clinical Pharmacy
 Collaborative?

What is the unique value proposition for
 those who join this collaborative?
                                           44
  Key Benefits of Participation
         in the PSPC
• It’s the Right Thing to Do for the Patients We Serve
   – Safer
   – More, Better Pharmacy Services
   – Improved Health Outcomes

• Reduces/Manages Risk – and Risk is Increasing

• Builds on and Takes Prior Experience to a New Level
   – Integrated
   – Takes HRSA Collaborative Experiences to the Next Power

                                                          45
  Key Benefits of Participation
         in the PSPC
• Integrates Services to Maximize Community Health

• Reduces Inappropriate Use of Polypharmacy – Better Medication
  Management

• Will Help Create New Partnerships & Synergies Across Provider
  Organizations

• Exposure to Cutting Edge People and Methods on Quality
  Improvement, Leadership & Change Management

• Chance to Be A Part of a Major National Movement in a
  Rewarding All Teach, All Learn Environment
                                                           46
   Value Proposition

Organizations can achieve better
  health outcomes for patients
through safer, integrated clinical
       pharmacy services.


                                 47
      Value Proposition
 System improvements in pharmacy will
   improve outcomes for your patients
     across a broad range of chronic
               conditions.

…we’re ready to go beyond improvements one
 disease at a time!

                                             48
What are some of the ways that “State”
 Organizations might help lead on the
               PSPC?
 • Helping Teams Get Ready for LS 1
 • Convening State-wide Learning Sessions in
   December and Spring, 2009 to match up with
   the national learning session --- downloading
   satellite feed of presenters (for example).
 • Modeling Cross-Organization Collaboration


                                              49
 Patient Safety and Clinical Pharmacy Services
              Collaborative (PSPC)
Communication
     HRSA Website
      www.hrsa.gov/patientsafety
     Questions?
      patientsafety@hrsa.gov
     HRSA Knowledge Management System
       www.healthdisparities.net
       National Leadership Series Calls: PSPC Calls
         stored in KMS library: Dec 19, 2007, Apr 9, 2008,
         May 8, 2008, May 28, 2008, and June 4, 2008
                                                             50
      Knowledge Management
• Web Address: www.healthdisparities.net

• Virtual Office and List-serv functionality

   – Virtual Office: Patient Safety and Pharmacy

• Increased sharing of tools and resources

• Expanding Knowledge Base and Library

• Contact for assistance: Fred Butler fbutler@hrsa.gov
                                                         51
        National Leadership Series
              PSPC Pre-Work

 July 22 -- 12 Noon to 1 PM EDT
   Pre-Work in preparation for LS#1


 July 30 -- 12 Noon to 1 PM EDT
   Pre-Work in preparation for LS#1




                                       52
Patient Safety & Clinical Pharmacy
  Collaborative – Next Steps??
•   Share the information with potential partners
•   Engage with community partners
•   Engage your senior leaders in the vision
•   Secure support for participation
•   Review participation package
•   Ask questions
•   Apply with your teams to participate

              What are you waiting for??
                                                    53
       Group Discussion and
           Processing

• What will you do back home to engage with
  others in your community?

• What requests and offers will you make that
  can help you succeed with this work?



                                                54
     www.hrsa.gov/patientsafety
       patientsafety@hrsa.gov
      www.healthdisparities.net

      IHI Breakthrough Series White Paper:

  http://www.ihi.org/IHI/Results/WhitePapers/
    TheBreakthroughSeriesIHIsCollaborative
ModelforAchieving+BreakthroughImprovement.htm


                                             55

				
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