scholarly journals Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015877 ◽  
Author(s):  
Nancy Winslade ◽  
Robyn Tamblyn
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Primary Outcome ◽  
Claims Data ◽  
Population Based ◽  
Professional Services ◽  
Administrative Claims ◽  
Antihypertensive Medications ◽  
Pharmacy Claims

ObjectiveTo determine if a prototype pharmacists’ services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists’ performance can be used to identify characteristics of pharmacies providing higher quality of care.DesignPopulation-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010.SettingAll community pharmacies in Quebec, Canada.Participants1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients.Primary outcome measurePatient adherence to antihypertensive medications.PredictorsPharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering.Results9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists’ services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains.ConclusionsPharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist’s professional services and continuity of pharmacist’s care.

scholarly journals Improving Completion Rates of Transcranial Doppler Ultrasounds in Children with Sickle Cell Disease Using Quality Improvement Efforts: In-Clinic Vs. Population-Based Assessments

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1886-1886
Author(s):  
Madhav Vissa ◽  
Marsha Treadwell ◽  
Naomi Bardach
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Chart Review ◽  
Claims Data ◽  
Administrative Claims ◽  
Completion Rates ◽  
Cell Disease

Abstract Introduction: People living with sickle cell disease (SCD) are at risk for stroke due to progressive cerebral vasculopathy. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) study showed that transfusion therapy in patients with abnormal cerebral blood flow velocities measured by transcranial doppler (TCD) ultrasound significantly reduced the risk for stroke. Based on the STOP and STOP II studies, the National Heart, Lung and Blood Institute (NHLBI) and American Society of Hematology (ASH) recommend annual TCD screenings for children with HbSS and HbSb0 genotypes from age 2-16. Despite this recommendation, studies show that fewer than half of eligible children with SCD complete annual TCD screening. Recently, Cabana and Treadwell et al. (2020) found high TCD referral and completion rates in a multi-site quality improvement (QI) initiative (85% baseline) using chart review. Another feasible approach to tracking guideline adherence uses administrative claims data which are derived from diagnostic and billing codes from statewide claims. Claims data can be used to assess population estimates for a clinic or a state, for all eligible patients, including those who may not routinely access care. In this study, we use administrative claims to assess TCD completion rates in the same clinics participating in the aforementioned QI initiative. We hypothesized that, population level rates would be lower than those assessed via chart review and that QI strategies may not lead to sustained TCD completion rates. Methods: Between August 2017 to August 2018, a QI initiative within the Pacific Sickle Cell Regional Collaborative (PSCRC) was conducted to improve referral and completion rates of TCD screenings. Site leads participated in a monthly QI learning collaborative, implementing and reporting on Plan-Do-Study-Act (PDSA) cycles, with bimonthly chart review data collection. Medicaid administrative claims from the four states with participating clinics, from 2017, 2018 (to assess baseline and post-QI initiative performance) and 2019 (to assess sustainability), were used to assess rates of TCD completion in the eligible pediatric population, using the specifications of a previously validated quality measure by Reeves et al (2019). Annual TCD completion rates and changes in completion rates over time were assessed for each site and state. Results: Five sites from four states in the PSCRC were included in the analysis. There was large variability in the number of eligible patients in each clinic (13-75) and state (23-588). Based on administrative claims, TCD clinic-level completion rates at baseline ranged from 41.7% to 69.2% at individual clinics. After 12 months of QI participation, TCD completion rates improved at all sites (range 4.6% to 29.2%). The site with the largest change improved TCD completion rate from 41.7% to 70.8% (n=24). All but one site had a decrease in TCD completion rate after completing the QI initiative and in 2019, TCD completion rates were within 10% of baseline completion rates at all sites (range -8.2% to 8.3%). At the statewide level, one state had a sustained improvement in TCD completion (improvement from baseline: 8.8%). In three of the four states providing data, TCD completion rates decreased from baseline (range -0.7% to -12.6%). Discussion: In a regional collaborative, we found improvements in TCD completion in the setting of a QI initiative focused on TCD, which were not sustained in the year after. This suggests the need for a systems-level approach to improvement, leading to feasible sustainability when no longer the focus of a collaborative. In addition, our data show that, when using administrative claims, rates of TCD completion are lower than rates when using chart review data (41.7% to 69.2% vs. 85% by chart review noted in prior publication). Thus, while site-specific medical record review provides insight into the quality of care for patients seen in the clinic, administrative claims data allow for a global understanding of the quality of care for the clinic population at risk, including those who do not attend clinic regularly. This suggests additional potential focus for quality improvement initiatives, such as systems to optimize outreach to patients who may not routinely access care. This type of outreach may best be done by health plans, potentially in partnership with sickle cell specialists, and would be an important tool for improving health for children with SCD. Disclosures Vissa: Global Blood Therapeutics Inc: Research Funding. Treadwell: National Alliance of Sickle Cell Centers: Other: Early Evaluation of the Use of Crizanlizumab in Sickle Cell Disease.

scholarly journals Blood Pressure Control and Other Quality of Care Metrics for Patients with Obesity and Diabetes: A Population-Based Cohort Study

2018 ◽  
Vol 25 (4) ◽  
pp. 391-399
Author(s):  
Jennifer T. Fink ◽  
Elizabeth M. Magnan ◽  
Heather M. Johnson ◽  
Lauren M. Bednarz ◽  
Glenn O. Allen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Quality Of Care ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Population Based ◽  
Obesity And Diabetes

scholarly journals Timely access and quality of care in colorectal cancer: a population-based cohort study using administrative data

2013 ◽  
Vol 6 (1) ◽  
Author(s):  
Geoffrey Porter ◽  
Robin Urquhart ◽  
Cynthia Kendell ◽  
Jingyu Bu ◽  
Yarrow McConnell ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Quality Of Care ◽  
Administrative Data ◽  
Population Based ◽  
Timely Access ◽  
Access And Quality

Breast cancer quality of care in Taiwan in relation to hospital volume: a population-based cohort study

2015 ◽  
Vol 11 (4) ◽  
pp. 308-313 ◽  
Author(s):  
Fu Ou-Yang ◽  
Nicholas C Hsu ◽  
Chiung-Hui Juan ◽  
Hsin-I Huang ◽  
Sin-Hua Moi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Quality Of Care ◽  
Hospital Volume ◽  
Population Based

scholarly journals Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study

2015 ◽  
Vol 45 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Pia Kjær Kristensen ◽  
Theis Muncholm Thillemann ◽  
Kjeld Søballe ◽  
Søren Paaske Johnsen
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Population Based

scholarly journals Quality of care for the dying across different levels of palliative care development: A population-based cohort study

2018 ◽  
Vol 32 (10) ◽  
pp. 1596-1604 ◽  
Author(s):  
Maria EC Schelin ◽  
Bengt Sallerfors ◽  
Birgit H Rasmussen ◽  
Carl Johan Fürst
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Quality Of Care ◽  
Population Based ◽  
Different Levels ◽  
Care Development

scholarly journals Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: a nationwide cohort study in Korea

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020974 ◽  
Author(s):  
Yongil Cho ◽  
Hyun Soo Park
Keyword(s):  
Cohort Study ◽  
Ventricular Arrhythmia ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Population Based ◽  
Administrative Claims ◽  
Increased Risk ◽  
Oral Ciprofloxacin ◽  
Reduced Risk

ObjectiveTo evaluate whether oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin increase the risk of ventricular arrhythmia in Korea’s general population.DesignPopulation-based cohort study using administrative claims data on a national scale in Korea.SettingAll primary, secondary and tertiary care settings from 1 January 2015 to 31 December 2015.ParticipantsPatients who were prescribed the relevant study medications at outpatient visits.Primary outcome measuresEach patient group that was prescribed ciprofloxacin, levofloxacin, ofloxacin or moxifloxacin was compared with the group that was prescribed cefixime to assess the risk of serious ventricular arrhythmia (ventricular tachycardia, fibrillation, flutter and cardiac arrest). Using logistic regression analysis with inverse probability of treatment weighting using the propensity score, OR and 95% CI for serious ventricular arrhythmia were calculated for days 1–7 and 8–14 after the patients commenced antibiotic use.ResultsDuring the study period, 4 888 890 patients were prescribed the study medications. They included 1 466 133 ciprofloxacin users, 1 141 961 levofloxacin users, 1 830 786 ofloxacin users, 47 080 moxifloxacin users and 402 930 cefixime users. Between 1 and 7 days after index date, there was no evidence of increased serious ventricular arrhythmia related to the prescription of ciprofloxacin (OR 0.72; 95% CI 0.49 to 1.06) and levofloxacin (OR 0.92; 95% CI 0.66 to 1.29). Ofloxacin had a 59% reduced risk of serious ventricular arrhythmia compared with cefixime during 1–7 days after prescription. Whereas the OR of serious ventricular arrhythmia after the prescription of moxifloxacin was 1.87 (95% CI 1.15 to 3.11) compared with cefixime during 1–7 days after prescription.ConclusionsDuring 1–7 days after prescription, ciprofloxacin and levofloxacin were not associated with increased risk and ofloxacin showed reduced risk of serious ventricular arrhythmia. Moxifloxacin increased the risk of serious ventricular arrhythmia.

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