Creation of an adherence assessment workflow through a quality improvement initiative.

Abstract

414 Background: Immunomodulatory therapies (IMIDs) have been shown to significantly improve overall survival and progression-free survival in patients with multiple myeloma. However, real-world adherence to IMIDs is not well documented. This quality improvement project aims to establish a process for adherence assessment documentation among patients taking IMIDs. Methods: A collaborative team was formed including pharmacists, a nurse, and an oncologist. Patients newly initiating IMID therapy (first 6 months of treatment) at Westerly and Waterford infusion sites were included for analysis. The baseline data period was a one-time lookback from the time of data availability through December 2022. Participating institutions completed a Qualtrics survey to quantify the magnitude of contributing factors for lack of adherence assessment, which were identified by a fishbone and process map. A Priority/Pay-off matrix elucidated the lowest effort and highest yield interventions. Plan-Do-Study-Act (PDSA) cycle methodology was used for post-intervention assessment, where Cycle 1 studied the impact of pharmacy team outreach using an Epic reminder list and SmartPhrase. Adherence rates to IMIDs were captured each month as a secondary outcome. This work was supported by a HOPA membership education initiative, which funded ASCO Quality Training Program participation. Results: The first PDSA cycle resulted in an adherence assessment rate of 80.5%. The inability to reach a patient via phone was the predominant reason for missing adherence assessment. Patients were classified as adherent in 81% (26/32) of encounters. Of encounters with nonadherence, 50% (3/6) had a delay in receiving their IMID. Conclusions: Our first PDSA intervention period resulted in a significant improvement in adherence assessment documentation, from 4.2% to 80.5% (Table 1). The inclusion of learners such as pharmacy students appears to improve adherence assessment feasibility. Limitations include a small study population (n=12) at two infusion centers in a single region (southern CT/RI). The next planned PDSA cycle is an Epic reminder list dedicated solely to IMID adherence assessment patients, enabling the pharmacy team to confirm all have scheduled follow-up.[Table: see text]