Quality Improvement Platform Research Articles

Experience Starting an Addiction Medicine Practice-based Research Network.

This paper outlines the experience developing Addiction Medicine Practice-Based Research Network (AMNet), which promotes the adoption of patient-reported outcome measures (PROMs) and measurement-based care in outpatient addiction treatment practices and creates a platform for quality improvement and research. From August 2019 to July 2023, the AMNet team selected patient-reported outcome measures for implementation in the American Psychiatric Association's clinical data registry (PsychPRO), recruited addiction medicine providers, and collected PROMs data. AMNet selected 12 PROMs for implementation in PsychPRO. Through July 2023, 1565 providers expressed interest, of whom 216 of the 929 eligible providers (23%) attended an onboarding call/webinar. Two hundred six providers (95%) from 54 practices returned Participation Agreements. Subsequently, 65 providers (32%) from 39 practices withdrew, resulting in 141 (68%) providers from 15 practices. From November 2020 to July 2023, 38 providers submitted PROMs data using 1 of 3 PsychPRO patient portals. Sixteen of the 53 providers (30%) who signed up for the initial portal collected data from 468 patients. As of July 2023, 83 of the 141 providers (59%) opted to submit PROMs data from their own portal or electronic health record. Next steps will include continued recruitment of providers, addressing barriers to data transfer and integrating data from providers' portals into the registry to create a platform for future research.

Evaluating Consent Labs: prioritizing sexual wellbeing through a youth-led, curriculum-based education initiative

IntroductionConsent Labs is an Australian, youth-led, not-for-profit organization delivering comprehensive consent education. Workshops are co-designed by young people and delivered by near-to-peer facilitators in secondary and tertiary institutions. The aims of this paper are (1) to describe the development, design and delivery of Consent Labs and (2) to conduct a retrospective analysis of evaluation data collected by Consent Labs.MethodsE-survey data were collected by workshop facilitators between March 2021 and April 2023. This paper presents a retrospective analysis of these de-identified data. Survey items included age, identity, pre- and post- sexual consent knowledge, attitudes towards the content and delivery and questions inviting free-text responses. Quantitative data were analyzed using descriptive statistics: frequencies, self-reported change in knowledge using paired t-tests, and differences between groups using chi-square tests. Free-text responses were analyzed using content analysis.ResultsWe describe the conceptualization of Consent Labs, present information about topics covered and report on process evaluation data analysis. Six thousand and twenty-six students returned complete evaluation surveys; 76.3% were school students and 23.7% were university students. The majority (67.3%) identified as female, 24.2% as male, 1.7% as non-binary, 1.2% as other gender identity. Self-reported change in knowledge before and after workshops was significant (pre-workshop knowledge mean score 3.77; post-workshop knowledge mean score 4.58; p < 0.0001). Change in knowledge remained significant when analyzed by institution, school type gender and sexual identity. ‘Consent Foundations’ was the most frequently selected (41.0%) topic as being most valuable. Respondents selected ‘Recognizing Coercion’ and ‘Gaslighting and Other Consent Challenges’ most frequently for future workshops (both 48.3%). Analysis of free text responses provided additional feedback.DiscussionConsent Labs has been gaining recognition nationally since it was first implemented; this is the first analysis of process evaluation data. Limitations of the study include the low response rate, self-reported change in knowledge and the cross-sectional nature of the evaluation. Preliminary findings are encouraging and provide a sound platform for quality improvement and further evaluation. A recent government grant to partner with education academics will ensure that the Consent Labs program and continuing growth will be informed by more rigorous evaluation and evidence.

Cohort profile: the European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart)-acute coronary syndrome and percutaneous coronary intervention.

The European Unified Registries On Heart Care Evaluation and Randomized Trials (EuroHeart) aims to improve the quality of care and clinical outcomes for patients with cardiovascular disease. The collaboration of acute coronary syndrome/percutaneous coronary intervention (ACS/PCI) registries is operational in seven vanguard European Society of Cardiology member countries. Adults admitted to hospitals with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are included, and individual patient-level data collected and aligned according to the internationally agreed EuroHeart data standards for ACS/PCI. The registries provide up to 155 variables spanning patient demographics and clinical characteristics, in-hospital care, in-hospital outcomes, and discharge medications. After performing statistical analyses on patient data, participating countries transfer aggregated data to EuroHeart for international reporting. Between 1st January 2022 and 31st December 2022, 40021 admissions (STEMI 46.7%, NSTEMI 53.3%) were recorded from 192 hospitals in the seven vanguard countries: Estonia, Hungary, Iceland, Portugal, Romania, Singapore, and Sweden. The mean age for the cohort was 67.9 (standard deviation 12.6) years, and it included 12628 (31.6%) women. The EuroHeart collaboration of ACS/PCI registries prospectively collects and analyses individual data for ACS and PCI at a national level, after which aggregated results are transferred to the EuroHeart Data Science Centre. The collaboration will expand to other countries and provide continuous insights into the provision of clinical care and outcomes for patients with ACS and undergoing PCI. It will serve as a unique international platform for quality improvement, observational research, and registry-based clinical trials.

Cardiac rehabilitation patient data management and quality improvement in Australia: A national survey

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council Synergy Grant Background Receipt of guideline-indicated comprehensive cardiac rehabilitation improves patient outcomes. Optimum service delivery and meeting quality standards necessitates accurate standardised data collection and reporting. The methods, processes and systems used for data capture and reporting in cardiac rehabilitation are under-documented, limiting identification of areas needing change and creation of a platform for quality improvement (QI) at national levels. Purpose To describe data capture, management, and reporting and the awareness and use of quality indicators in contemporary Australian CR programs. Methods CR programs (n=396) were identified through professional and national directories, jurisdictional networks, webinars, and direct provider contact. Program coordinators completed an online survey on individual service characteristics, data capture and management systems (paper, electronic, database, integrated platform) including awareness, use and usefulness of the published National Cardiac Rehabilitation Quality toolkit components. Results Respondents totalled 319 (80.5%), from all eight states and territories. Coverage of Metropolitan, rural and remote towns, and regional centres was 46.3%, 45.9% and 7.8%, respectively. Indicative annual patient enrolments were >200 (31.0%), 51-200 (46.4%) and ≤50 (22.6%). Most programs used ≥2 data management systems: paper and electronic 62.6% or multiple e-systems 19.1%, or one system, either paper 20.9% or electronic 16.3%. Use of multiple systems and combinations of systems did not differ by number of patients enrolled. QI systems were infrequently used: QI Platforms 17.2%, QI Databases 10.0%. Supplementary to patient care, data gained was used for reports for management (57.0%), QI (56.1%), funding support (43.2%), required jurisdictional reporting (41.1%) and research (30.7%). Higher volume programs were more likely to be using the data capture for multiple purposes. Independent covariates of services using data for QI were enrolments of >200 (OR 3.83 95% CI 1.76, 8.34) and the state/territory location, such that use of QI was less likely in the states of Victoria (OR 0.24 95% CI 0.08, 0.77), New South Wales (OR 0.25 95% CI 0.08, 0.76) and Western Australia (OR 0.16 95% CI 0.05, 0.57). Conclusions Management of cardiac rehabilitation patient data is highly variable across Australian programs and jurisdictions, often including multiple different systems, with limited use of the data for QI. A national user-friendly, low burden approach to CR data collection incorporated into daily work-flow that is capable of benchmarking and informs QI is essential.

Show me the money: how do we justify spending health care dollars on digital health?

Show me the money: how do we justify spending health care dollars on digital health?

Impact of COVID-19 pandemic on catheter ablation in China: A spatiotemporal analysis.

The COVID-19 pandemic has significantly impacted routine cardiovascular health assessments and services. We aim to depict the temporal trend of catheter ablation (CA) and provide experience in dealing with the negative impact of the COVID-19 pandemic. Data on CA between January 2019, and December 2021, were extracted from the National Center for Cardiovascular Quality Improvement platform. CA alterations from 2019 to 2021 were assessed with a generalized estimation equation. A total of 347,924 patients undergoing CA were included in the final analysis. The CA decreased remarkably from 122,839 in 2019 to 100,019 (-18.58%, 95% CI: -33.40% to -3.75%, p = 0.02) in 2020, and increased slightly to 125,006 (1.81%, 95% CI: -7.01% to 3.38%, p = 0.49) in 2021. The CA experienced the maximal reduction in February 2020 (-88.78%) corresponding with the peak of monthly new COVID-19 cases and decreased by 54.32% (95%CI: -71.27% to -37.37%, p < 0.001) during the 3-month lockdown and increased firstly in June 2020 relative to 2019. Since then, the CA in 2020 remained unchanged relative to 2019 (-0.06%, 95% CI: -7.01% to 3.38%, p = 0.98). Notably, the recovery of CA in 2021 to pre-COVID-19 levels was mainly driven by the growth of CA in secondary hospitals. Although there is a slight increase (2167) in CA in 2021 relative to 2019, both the absolute number and proportion of CA in the top 50 hospitals nationwide [53,887 (43.09%) vs. 63,811 (51.95%), p < 0.001] and top three hospitals in each province [66,152 (52.73%) vs. 72,392 (59.28%), p < 0.001] still declined significantly. The CA experienced a substantial decline during the early phase of the COVID-19 pandemic, and then gradually returned to pre-COVID-19 levels. Notably, the growth of CA in secondary hospitals plays an important role in the overall resumption, which implies that systematic guidance of secondary hospitals with CA experience may aid in mitigating the negative impact of the COVID-19 pandemic.

Health worker perspectives of Smart Triage, a digital triaging platform for quality improvement at a referral hospital in Uganda: a qualitative analysis

BackgroundEffective triage at hospitals can improve outcomes for children globally by helping identify and prioritize care for those most at-risk of death. Paper-based pediatric triage guidelines have been developed to support frontline health workers in low-resource settings, but these guidelines can be challenging to implement. Smart Triage is a digital triaging platform for quality improvement (QI) that aims to address this challenge. Smart Triage represents a major cultural and behavioural shift in terms of managing patients at health facilities in low-and middle-income countries. The purpose of this study is to understand user perspectives on the usability, feasibility, and acceptability of Smart Triage to inform ongoing and future implementation.MethodsThis was a descriptive qualitative study comprising of face-to-face interviews with health workers (n = 15) at a regional referral hospital in Eastern Uganda, conducted as a sub-study of a larger clinical trial to evaluate Smart Triage (NCT04304235). Thematic analysis was used to assess the usability, feasibility, and acceptability of the platform, focusing on its use in stratifying and prioritizing patients according to their risk and informing QI initiatives implemented by health workers.ResultsWith appropriate training and experience, health workers found most features of Smart Triage usable and feasible to implement, and reported the platform was acceptable due to its positive impact on reducing the time to treatment for emergency pediatric cases and its use in informing QI initiatives within the pediatric ward. Several factors that reduced the feasibility and acceptability were identified, including high staff turnover, a lack of medical supplies at the hospital, and challenges with staff attitudes.ConclusionHealth workers can use the Smart Triage digital triaging platform to identify and prioritize care for severely ill children and improve quality of care at health facilities in low-resource settings. Future innovation is needed to address identified feasibility and acceptability challenges; however, this platform could potentially address some of the challenges to implementing current paper-based systems.

Epidemiologie des Kreislaufstillstands in Europa

In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in- and out-of-hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to provide support for health system planning and responses to cardiac arrest.

European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe

In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.

Behind closed doors: What happens when pharmacies close?

Behind closed doors: What happens when pharmacies close?

Diagnostic coronary angiography and percutaneous coronary intervention practices in New Zealand: The All New Zealand Acute Coronary Syndrome-Quality Improvement CathPCI registry 3-year study (ANZACS-QI 37)

BackgroundCoronary heart disease remains one of the leading causes of mortality and morbidity in New Zealand (NZ) and globally. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme includes the CathPCI registry which records all those referred for diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) in NZ. We present the methods and three-years of data from the ANZACS-QI CathPCI registry. MethodsThe data was extracted from the ANZACS QI CathPCI registry from 01/09/2014 to 24/09/2017. The ANZACS-QI data dictionary defines all the clinical, procedural and outcomes variables collected, and standard statistical analyses were applied. Results40,870 patients underwent cardiac catheterisation, with a mean age of 65 years, and males making up 67% of the cohort. Indications included acute coronary syndrome 55%, angina with suspected stable coronary disease 28%, valve surgery workup 8%, planned PCI 3%, heart failure/cardiomyopathy 3%, arrhythmia 1% and other 2%. For those undergoing DCA alone, radial access was used in 85% and two-thirds had at least one major artery with >50% stenosis. PCI was performed in 39% of patients. Drug-eluting stents were used in 97%. ConclusionThe CathPCI registry records the characteristics and outcomes of all patients undergoing DCA and PCI in NZ hospitals. As part of the ANZACS-QI programme the registry provides an important platform for quality improvement, research and to inform clinical practice.

A Novel, Web-Based Quality Improvement Platform to Address ACGME CLER Requirements.

In 2014, the Accreditation Council for Graduate Medical Education (ACGME) formally mandated trainee (resident and fellow) participation in health care quality improvement (QI) projects as one of the Clinical Learning Environment Review (CLER) Pathways to Excellence. Subsequent national reviews showed large variations in how QI education is conducted, as well as a significant mismatch between educational and organizational goals. We developed a web-based platform to engage trainees in QI that better aligned with best practice methodology and matched identified institutional priorities. A needs assessment survey was distributed to trainees to understand the obstacles to compliance with ACGME QI requirements. Based on the results, a web-based clearinghouse, called the QI Platform, was developed and launched in July 2016, and utilization was analyzed in February 2019. A total of 196 of 440 needs assessment surveys (45%) were completed. Themes extracted from surveys to identify barriers in QI participation included difficulties designing projects, lack of mentorship or expert support, and difficulty engaging an interprofessional team. Over 2.5 years, 151 projects were registered on the platform. Of these, 17 (11%) were collaborative entries. At the time of analysis, 166 of 437 trainees (38%) were listed as participants in active QI projects. A total of 22 projects were archived as complete, and 68 incomplete projects were reassigned to the "Ideas" section as works in progress after lead trainee graduation. An institutional QI Platform clearinghouse for GME QI projects was feasible to develop and maintain, and it appeared acceptable to most GME programs and trainees for recording and tracking QI projects, and linking these to hospital QI priorities.

Adherence to a strict medication protocol can reduce length of stay in hospitalized patients with Parkinson's Disease

BackgroundPatients with Parkinson's Disease (PD) are at higher risk of complications when admitted to the hospital. Delays in PD medications and use of contraindicated medications contribute to the increased risk and prolong their lengths of stay (LOS). Using a hospital-wide PD protocol, we aimed to ensure PD medications were placed with “custom” timing to resemble the home schedules, and also to avoid ordering or administering contraindicated medications. Material and methods569 patients admitted in 2017 and 2018, were reviewed retrospectively. Mean age was 76.5 (SD 10.6), 332 were males and 237 were females. Charts were reviewed to assess if A) PD medications were ordered with custom timing, B) if not, were the orders changed to custom timed C) if contraindicated medications were ordered, and D) if they were administered. We also assessed the actual/expected length of stay during this time period. Chi Square and post hoc analyses were done to compare time points. Poisson regression analysis was done to assess relative improvement of variables. ResultsThere was a 2.7 fold increase in orders placed with custom timing in 2018 compared to 2017 (RR = 2.651, 95%CI: 1.860–3.780, p < 0.0001), and a 3.2 fold increase in correction of non-custom orders in the same time period (RR = 3.246, 95%CI: 1.875–1.619, p < 0.0001). We also observed a decrease in the actual/expected LOS ratio from 1.54 to 1.32 (p < 0.05). ConclusionBy utilizing an established platform for quality improvement, we were able to improve adherence to the home medication regimen timing in admitted PD patients. Our findings also suggests that adherence to a strict medication regimen protocol may decrease LOS for this patient population.

Reduction of defects in the lapping process of the silicon wafer manufacturing: the Six Sigma application

Abstract Aiming to reduce flatness (Total Thickness Variation, TTV) defects in the lapping process of the silicon wafer manufacturing, it is crucial to understand and eliminate the root cause(s). Financial losses resulting from TTV defects make the lapping process unsustainable. DMAIC (Define, Measure, Analyse, Improve and Control), which is a Six Sigma methodology, was implemented to improve the quality of the silicon wafer manufacturing process. The study design and the choice of procedures were contingent on customer requirements and customised to ensure maximum satisfaction; which is the underlying principle of the rigorous, statistical technique of Six Sigma. Previously unknown causes of high TTV reject rates were identified, and a massive reduction in the TTV reject rate was achieved (from 4.43% to 0.02%). Also, the lapping process capability (Ppk) increased to 3.87 (beyond the required standard of 1.67), suggesting sustainable long-term stability. Control procedures were also effectively implemented using the techniques of poka yoke and control charts. This paper explores the utility of Six Sigma, a quality management technique, to improve the quality of a process used in the semiconductor industry. The application of the Six Sigma methodology in the current project provides an example of the root cause investigation methodology that can be adopted for similar processes or industries. Some of the statistical tools and techniques were used for the first time in this project, thereby providing new analysis and quality improvement platform for the future. The article offers a deeper understanding of the factors that impact on the silicon wafer flatness in the lapping process. It also highlights the benefits of using a structured problem-solving methodology like Six Sigma.

Assessment of Patient Education about Statin Therapy on Quality Measures and Knowledge in an Independent Community Pharmacy.

The objectives were to 1) assess the possible impact of face-to-face patient education on Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) performance scores, 2) determine if face-to-face patient education increased overall knowledge and number of identified patients on statin therapy, and 3) identify barriers to statin therapy in targeted patients with diabetes. Participants received an anonymous survey tool collecting demographic data and assessing barriers, baseline knowledge, and perceptions about statin therapy. Following the initial survey, participants received education from the pharmacist describing the risks and benefits of statin therapy and were given a supplemental pamphlet. A second post-education survey tool was given to assess posteducation knowledge and perceptions. At the end of the study period, investigators assessed the number of participants started on statin therapy and calculated the predicted percentage change in EQuIPP score. This study was conducted at Waterfront Family Pharmacy in Morgantown, West Virginia from December 2017 until April 2018. Participants were included if aged 40 to 75, received at least two fills of a diabetes medication at the pharmacy in the last year, had not taking a statin within a year prior to participating in the study, and could read and write in English. The primary outcome measure was the predicted percentage change in the "Statin Use in Diabetes" EQuIPP Score. Secondary measures included post-educational knowledge and perceptions of statin therapy. During the study period, 10 participants completed the surveys and educational intervention. The predicted change in "Statin Use in Diabetes" EQuIPP score was an increase from 75% to 76.9% (+ 1.9%). Prior to the educational intervention, none of the participants could identify a benefit of statin therapy aside from lowering cholesterol. After the intervention, 80% of participants could identify at least one additional benefit of statin therapy. Before the intervention, 30% of participants stated they would consider taking a statin, which increased to 80% following the pharmacist-led education. Lastly, no participants felt they needed to be on statin therapy prior to the intervention. Following the intervention, 40% stated they believed they were candidates for statin therapy. Patients are willing to receive education from pharmacists about their medications and are receptive to general recommendations. A common modifiable barrier to statin therapy is patient knowledge, emphasizing the importance of pharmacistprovided education. Education about statin therapy may also increase EQuIPP scores in an independent community pharmacy, leading to better outcomes for patients and improvement of common performance measures. Overall, it appears patients require more education about statin therapy and the benefit these drugs can provide aside from their cholesterol lowering properties. Pharmacistprovided education regarding statins in patients with diabetes can increase performance measures monitored by third party payers.

Measuring the Impact of Academic Cancer Network Development on Clinical Integration, Quality of Care, and Patient Satisfaction

Many US academic centers have acquired community practices to expand their clinical care and research footprint. The objective of this assessment was to determine whether the acquisition and integration of community oncology practices by Yale/Smilow Cancer Hospital improved outcomes in quality of care, disease team integration, clinical trial accrual, and patient satisfaction at network practice sites. We evaluated quality of care by testing the hypothesis that core Quality Oncology Practice Initiative measures at network sites that were acquired in 2012 were significantly different after their 2016 integration into the network. Clinical and research integration were measured using the number of tumor board case presentations and total accruals in clinical trials. We used Press-Ganey scores to measure patient satisfaction pre- and postintegration. Mean Quality Oncology Practice Initiative scores at Smilow Care Centers were significantly higher in 2016 than in 2012 for core measures related to improvement in tumor staging ( z = 1.33; P < .05), signed consent and documentation plans for antineoplastic treatment ( z = 2.69; P < .01; and z = 2.36; P < .05, respectively), and appropriately quantifying and addressing pain during office visits ( z = 2.95; P < .05; and z = 3.1; P < .01, respectively). A total of 493 cases were presented by care center physicians at the tumor board in 2017 compared with 45 presented in 2013. Compared with 2012, Smilow Care Center clinical trial accrual increased from 25 to 170 patients in 2017. Last, patient satisfaction has remained at greater than the 90th percentile pre- and postintegration. The process of integration facilitates the ability to standardize cancer practice and provides a platform for quality improvement.

Positive Impact of Technician-Driven MTM Program on Performance Measures

Objective: To determine the effect of using a technician-driven medication therapy management (MTM) program on quality performance measures for a community pharmacy chain. Methods: A technician-driven MTM program was incorporated in 35 stores of a regional supermarket pharmacy chain. The overall chain percentage score for the 4 quality measures used in Medicare Part D Star Ratings—proportion of days covered (PDC) for cholesterol, diabetes, renin–angiotensin system antagonists (RASA), and high-risk medication use—was compared pre- and postimplementation of the technician-driven MTM program. Data were collected from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform and t tests were used to analyze 1 year pre- and postimplementation. Results: The PDC for RASA, high cholesterol medications, and diabetes medications significantly increased pre- to postimplementation for each drug class (P < .001, P = .011, P = .001, respectively). The combined overall mean PDC score for RASA, cholesterol medications, and diabetes medication classes significantly increased by 5.6% from 2015 to 2016 (74.2% vs 79.8%, P < .001); there was also a nonsignificant decrease in high-risk medication use for the entire chain. Conclusions This technician-driven MTM program can positively affect pharmacy quality performance and potentially improve patient outcomes.

Community pharmacist–led intervention to identify persons with diabetes not on statin therapy

ObjectivesTo demonstrate the effectiveness of a community pharmacist–led intervention to identify persons with diabetes not receiving statin therapy. SettingFive pharmacy locations within 1 district of a chain community pharmacy. Practice descriptionWalgreens Pharmacy is a national retail chain community pharmacy with global affiliations. Walgreens Pharmacy locations use clinical pharmacy services to provide complete quality patient care. Practice innovationA pharmacist intervention workflow model and screening algorithm for the Centers for Medicare and Medicaid Services (CMS) Statin Use in Persons with Diabetes quality measure were developed to identify measure-eligible patients in a community pharmacy setting. This new measure was implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard. The study aimed to demonstrate that community pharmacist intervention is effective for helping to close therapy gaps; the focus of this study was identifying patients who have diabetes but are not on statin therapy. EvaluationThe primary outcome included the percentage of patients flagged for intervention by the pharmacist, and the secondary outcome included the number of statin prescriptions received for the measure-eligible intervention population. ResultsAt study initiation, EQuIPP reported a total of 103 patients were SUPD measure eligible at the intervention pharmacies (combined). After the 90-day study duration, 29.1% (n = 30) of SUPD measure–eligible patients were identified with the use of the workflow intervention. From those identified, 40% (n = 12) gave verbal consent for the pharmacist to intervene with their physician, and of those, 58.3% (n = 7) received statin prescriptions. Pharmacy A increased their EQuIPP-based performance measure by 3.3%, Pharmacy B 4.2%, Pharmacy D 2.4%, and Pharmacy E 3.5%, and Pharmacy C decreased by 1.0%. ConclusionImplementation of a community pharmacist–led identification process successfully identified SUPD measure–eligible patients. Community pharmacist–led intervention resulted in an increase in the number of statin prescriptions written for measure-eligible patients.

Impact of Appointment-Based Medication Synchronization on Proportion of Days Covered for Chronic Medications

Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan’s Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.

The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families.

Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates.