US. Pharm. 2018;43(11)(Specialty&Oncology suppl):2.
The Triple Aim Initiative from the Institute for Healthcare Improvement provides a framework for optimizing health-system performance: improved patient experience of care, improved health of populations, and reduced per capita cost of healthcare. A measure—the numerator divided by the denominator—can help specialty pharmacies align and achieve the Triple Aim Initiative. Metrics are used for evaluating performance—for example, comparing one provider to another—or internal improvement, assessing change over time compared to baseline.
Metrics for evaluating internal improvement are commonly called key performance indicators (KPIs) or quality-improvement indicators (QIIs). The key differences between KPIs/QIIs and performance measures are that the latter are fully specified, are designed to assess specific populations, and have passed rigorous validity and reliability testing requirements, which makes them appropriate for performance comparisons. KPIs or QIIs, on the other hand, often are not put through the same rigor, and therefore may not be appropriate for comparisons across organizations.
Both KPIs/QIIs and performance measures play a role in specialty practice. First, KPIs/QIIs allow specialty providers to track their own performance over time— for example, year-to-year or quarter-to-quarter. These internal metrics provide benchmarks for continuous quality-improvement initiatives, or the kindling for managing change. Alternatively, performance measures designed for comparison across providers or across organizations have a role in external marketing and network evaluation. Performance measures undergo rigorous testing to ensure that the characteristics meet performance-comparison requirements. KPIs/QIIs may have inconsistencies with various facets of the measure specifications (denominator exclusions, numerator assessment criteria, target populations/medications, and other variables) when used to compare one organization to another.
Consider the KPI of turnaround time—essentially, the time from a specialty pharmacy receiving the referral to delivery of medication to a patient. Two different specialty providers may report an average turnaround time; however, the populations could be dramatically different. Each pharmacy may define medications in the metric differently, which has major consequences for calculating turnaround time. The first pharmacy may define the denominator as any medication dispensed by the pharmacy, including traditional medications like metformin, whereas the second pharmacy may define the denominator as a specific set of specialty medications only. This KPI is not an appropriate comparison between the two pharmacies because they identify different denominator populations.
Established quality metrics allow consistent comparisons between specialty pharmacies. Similar to accreditation for specialty pharmacies, quality measures can be endorsed for meeting rigorous testing standards. The National Quality Forum is one organization that can provide endorsement of quality measures that meet these requirements. Specialty pharmacies should look to these endorsed measures, which provide a consistent and standard evaluation of performance.
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