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PPRNet2014 Annual Meeting
©PPRNet 2014
NEW PROJECT
Reducing ADEs from Anticoagulants, Diabetes Agents and Opioids in Primary Care
PPRNet2014 Annual Meeting
©PPRNet 2014
GOALS
• Present newly funded medication safety project
• Discuss opportunities for practice and patient involvement
• Plan your role in the project
PPRNet2014 Annual Meeting
©PPRNet 2014
PPRNet2014 Annual Meeting
©PPRNet 2014
WHY?
• High priority medications
“ADEs across inpatient and outpatient settings are common, clinically signficant, preventable and measurable”– Anticoagulants– Diabetes agents– Opioids
PPRNet2014 Annual Meeting
©PPRNet 2014
• Focus on high priority medications • “…address the prevention of harm, but also
promote standardized and idealized practices and behaviors”
• Include patients as a vital part of research• Target ambulatory care
Advancing Patient Safety Implementation through Safe Medication Use Research
(PA-14-002)
PPRNet2014 Annual Meeting
©PPRNet 2014
PPRNet2014 Annual Meeting
©PPRNet 2014
TIMELINE
June-July 2014
“Good” scoreRespond to criticisms
January 25, 2014
Application submitted
December 2013 – January 2014Project planning
Request letters of support
November 2013
Funding Announcement
posted
PPRNet2014 Annual Meeting
©PPRNet 2014
PROJECT GOALS
1) Clarify risk factors for ADEs from high priority medications through a literature review and translate them into a working set of clinical quality measures that can be implemented in primary care
2) Use a community engaged action (CEA) research approach to test the impact of a refined set of preventive strategies for ADEs on practice performance on ADE clinical quality measures
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: DEVELOP ADE MEASURES
• Preliminary set of measures– Based on established risk
factors– Include existing or
proposed MU measures• Existing Stage 2 MU measures• Proposed Stage 3 MU measures• Proposed by research team
based on National Action Plan
– Revise based on provider input during year 1
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor
Lack of safe prescribing and monitoring processes for new oral anticoagulants
• Example: Anticoagulants
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor CQM
Lack of safe prescribing and monitoring processes for new oral anticoagulants
Patients on appropriate doses of new oral anticoagulants based on renal function
• Example: Anticoagulants
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor
Application of aggressive glycemic targets in high risk patients
• Example: Diabetes Agents
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor CQM
Application of aggressive glycemic targets in high risk patients
Patients > 65 years with diabetes on sulfonylurea or insulin AND most recent A1C > 7%
Patients with specific comorbidities* on sulfonylurea or insulin AND most recent A1C > 7%
• Example: Diabetes Agents
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor
Higher than recommended daily doses
• Example: Opioids
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: PRELIMINARY MEASURES
ADE Risk Factor CQM
Higher than recommended daily doses
Patients on recommended doses of long-term opioid therapy
• Example: Opioids
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 1: MEASURE DEVELOPMENT
Activity Timeline
Confirm participation of 24 practices Today!
Clarify ADE risk factors Oct 2014
Specify measures Dec 2014
Survey providers “Is this a useful measure of quality?” Open comments
Early 2015
PPRNet2014 Annual Meeting
©PPRNet 2014
GOAL 2: TEST “COMMUNITY ENGAGED” APPROACH
• Practice community = patients or non-professional caregivers, clinical staff and providers
• Site visits and regular follow-up• Purpose:
– Academic detailing on ADE risk factors
– Performance review and improvement planning
– Practice-specific integration of strategies to prevent ADEs
PPRNet2014 Annual Meeting
©PPRNet 2014
YES, PATIENTS!
• Practice invites 9-12 patients or non-professional caregivers to participate – From PPRNet list of patients eligible for CQMs
• Ideal characteristics of “key informants”– Ability to communicate clearly– Interest in project goal– Willingness to participate in site visits– Together, represent diverse age groups,
race/ethnicity, medications
PPRNet2014 Annual Meeting
©PPRNet 2014
Community Engaged Group(12 practices)
Control Group
(12 practices)
Provider surveys X X
Reports on ADE measures X X
Site visits with patient “key informants”
X
Regular follow-up via webinar/email
X
PPRNet2014 Annual Meeting
©PPRNet 2014
WHAT IS REQUIRED OF PRACTICES?
• Open to all members!• Submit PPRNet data extracts
through Sept 2017• Complete two rounds of
measure development survey• Agree to invite patients to
participate AND host 3 site visits if randomized to intervention
PPRNet2014 Annual Meeting
©PPRNet 2014
INCENTIVES TO PARTICIPATE
• Opportunity to define “meaningful” CQMs• Facilitated PPRNet quality and safety
improvement assistance• Concrete example for PCMH “Patient
Advisory Council” objective• Financial incentives for practices ($1200
each + $800/intervention) and patient advisors ($25/activity)
PPRNet2014 Annual Meeting
©PPRNet 2014
LETTERS OF SUPPORT
• We received letters of support from 15 practices in attendance:
Advanzed Health Care PLCCayuga Family MedicineDutter Hufford Daley MDsFamily Medicine of Port AngelesFamily Practice Associates, LLPLovelace Family MedicineNortheast Iowa Medical Education FoundationPlymouth Family Physicians
Quality Family PracticeRavalli Family MedicineRio Grande MedicineSmoky Hill Family Medicine Residency ProgramSpringfield Health CareSummit View ClinicThe Internal Medicine and Pediatric Clinic of New Albany
PPRNet2014 Annual Meeting
©PPRNet 2014
IT’S NOT TOO LATE!
Byron Center Family MedicineChatuge Family PracticeClover Fork ClinicDiana Lozano, MD, PA Family Health AssociatesFulton Family Health AssociatesGeorgia Regents Family Medicine Center Good Samaritan Health Center of CobbHilliard Family MedicineHugh D. Durrence, MDJohn A. Martin Primary Health Care Center
Lake Lansing Family PracticeMatthew White, MDMt View Family PracticeNatural Family WellnessNew London Family PracticeRobert E. Barnett, M.D. LLC Rio Grande Valley Adult and Internal MedicineSkyline Family PracticeSopris Medical PracticeSouth Park Internal Medicine UT Health Systems
PPRNet2014 Annual Meeting
©PPRNet 2014
ARE YOU IN?
• Yes
• Yes, awaiting confirmation from the rest of my practice
• No because …
PPRNet2014 Annual Meeting
©PPRNet 2014