Performance Improvement and quality tracking is an integral part of the corporate culture of excelleRx. Since the inception of excelleRx, there has been an active Quality Assurance department, responsible to document reported occurrences, perform root cause analysis, create resolution plans and work with clients to resolve issues and communicate improvement in performance. The services provided by the QA department, including problem resolution and standard reporting, score high in client satisfaction surveys and are considered a valuable reason for contracting with excelleRx for pharmacy services.

The clients served by excelleRx are accredited by state and federal agencies, as well as independent credentialing services including JCAHO and CHAP. These accrediting agencies require some level of QA reporting and some type of active QA system. The systems and services provided by excelleRx meet the minimum standards of those agencies credentialing our clients.

To retain a leadership position within our industry, the excelleRx QA system and department are positioned to meet the considerable growth within our organization and within the clients we serve, as well as the national changes regarding QA/PI in the healthcare marketplace.

The excelleRx QA Tracking System:  The QA system is powered by tracking software used in QA departments across fortune 500 companies. It is effective in documenting occurrences and reporting on single events. The system is scalable, automates workflow handling, allows trending and reporting sophistication.


Performance Improvement
Through review of customer needs, process evaluation, quality exceptions, regulatory and accreditation standards, as well as reports of near misses, the excelleRx team establishes performance improvement initiatives.  Project management process design is used to outline the performance plan, evaluation, resolution benchmarks and outcome tracking.


Clinical QA/PI Programs at HP
In the proposed rule published last May, CMS reorganized the standards into four primary sections—one of which is a section devoted to Quality Assurance/Performance Improvement (QA/PI). These changes focus on outcome driven care and place a major emphasis on data collection and analysis to drive care planning and to improve quality.

The QAPI focus provides a strong incentive to hospices to develop data collection strategies. When published, the final rule will likely look somewhat different from the proposed rule. However, the signs clearly point toward requirement of auditable systems for collecting, analyzing, and acting on patient outcomes data to improve care. Hospice Pharmacia can help. We already track numerous process and outcomes measures that are available in Xeris through easily downloaded reports, and in 2006 we will introduce exciting enhancements to our data collection and reporting tools.


Pharmacists Assessments Lead to Better Outcomes
Pharmacists ask a variety of questions during encounters with hospice nurses to plan medication therapy. You might wonder what we do with this information. The data is used during the encounter to make the best clinical judgment about therapy and to document and track our assessment details and patient outcomes. Fortunately for those who partner with us, we already track the proposed requirements.

Under the proposed rule, "the patient's comprehensive assessment would have to include a review of the patient's current medication. The review and accompanying documentation would include identification of:

1) Ineffective drug therapy;
2) Unwanted side and toxic effects; and
3) Drug interactions.”

"This review must be repeated as necessary to ensure that the patient continues to receive drug therapy that is effective and appropriate for his or her needs. A review of the patient's drugs would be included in the initial assessment and development of the plan of care. This review could occur at any time, but specifically when a patient is prescribed or begins to take any new drug and/or when use of a drug is discontinued."


Adverse Events Tracking
CMS proposed that the QAPI program must include, "...an ongoing program that is able to show measurable improvement in indicators that are linked to improving palliative outcomes and end-of-life support services…The hospice must measure, analyze and track these quality indicators, including areas such as adverse patient events and other aspects of performance that assess processes of care, hospice services and operations. Adverse patient events...are occurrences that are harmful or contrary to the targeted patient outcomes."  At HP, we already track potential and actual medication-related problems and adverse drug events.


Patient Outcomes
We have developed and are testing new data collection and reporting strategies to meet the growing needs of our hospice partners. Given the increased focus on measuring patient outcomes, we are readying several new products that will enable hospices to more easily collect patient self-reported symptom and quality of life outcomes. In our pilot launch of “patient-Reported Outcome measures (PROM), participating hospices have received real-time patient-level and organization-level reports and have applied these data during care planning at IDG meetings and in QA/PI projects. In addition, we are developing a methodology that will enable hospices to easily collect and report NHPCO End Result Outcomes. We look forward to making these new products and services available to our hospice partners this year.