Guest Commentary: A Fellow's Reflections on the 10th Annual Quality Colloquium

Zoe Clancy, PharmD

Fellow, Health Economics & Outcomes Research

Jefferson School of Population Health



In the words of Paul Wallace, MD, co-chair of the Harvard Tenth Quality Colloquium, “The test if you learned something is if you can go back home and talk about it.” This past week I attended the Tenth Quality Colloquium and I would like to think that I learned a lot. This is the first professional conference I have attended as a Health Economics and Outcomes Research Fellow at the School of Population Health and it was a rewarding experience.



Attending this conference has really highlighted a lot of topics and issues that I am learning about through the fellowship. The sessions I attended on health informatics, value-based purchasing, and quality improvement in the patient experience were led by leaders in their fields. Many topics about the culture of safety were discussed, such as accountable care organizations, meaningful use, and electronic health records.



The session devoted to Using Data to Improve Health Care Quality, Safety and Efficacy was interesting to me as a fellow in an outcomes research program. One of the main ideas I learned from the session was that data banks and the amount of information may be growing, but Health Informatics is still only a tool to access that data. Automating healthcare is important, but it is not enough. Training of personnel in informatics is needed in order to use data collection to its full potential.



In the Value-Based Purchasing seminar I became more familiar with Meaningful Use and other quality incentive programs. I was first exposed to these concepts by working with the JUP Quality Improvement team here at Jefferson, and after attending the session I look forward to applying what I learned to future JUP projects.



I noticed that pharmacists were mentioned frequently during the colloquium. It was brought up numerous times that pharmacists, being the medication experts, can play a crucial and valuable role in patient safety by becoming involved in medication safety. As a pharmacist, I am inspired by all that I heard, and am energized to utilize those principles in my fellowship.



I look forward to the opportunity to attend more conferences and sessions like the Tenth Quality Colloquium in the future.

The 10th Annual Quality Colloquium at Harvard

For four days this week the leaders in the quality and safety movement from all over the nation converged on the campus of Harvard University for the 10th Annual Quality Colloquium co sponsored by the Jefferson School of Population Health. In the first morning of the program, three key leaders, including the CEO of the IHI in Boston, the National Patient Safety Foundation, and the AHRQ, set the tone for the rest of the week by challenging the audience to get further engaged in the movement.These leaders reminded us all that medical error remains the fourth leading cause of death in the US and more must be done to protect our patients from harm. The research presentations covered a wide range of topics including the latest research on safety improvement in both the hospital and the office setting. Others presented an update on the role of hospital governance in quality and called for a renewed commitment on the part of board members to this agenda. In the pre conference workshop, nearly 100 persons spent a day in a special "boot camp", with myself and my colleage Dr Ed Walker from the University of Washington in Seattle. Together, we gave a day long overview of the field and we too challenged the attendees to return to their home institutions with a renewed sense of energy and new tools to tackle the epidemic of harmful errors. Our team is already hard at work planning the August 2012 session!! I sure hope that you will think about joining us next summer. DAVID NASH

Guest Commentary: Collaborative Care's Crucial Role in Population Health

Amanda Solis, MS

Project Director

Jefferson School of Population Health



A focus on population health requires a creative and collaborative approach to care.

The traditional perspective in healthcare has been fairly physician-focused. As we seek to fulfill the mandate to become more patient-centered in our outlook, it is important to leverage the important roles of pharmacists, physical therapists, nurses, nurse practitioners and physician assistants, health coaches and nutritionists.



To illustrate my point, here is one example of the role a collaborative care team can play in the management of chronic disease that specifically highlights the community pharmacist. Beginning in 2006, the American Pharmacists Association (APhA) launched a program named the “Diabetes Ten City Challenge.” Originally born from the Asheville Project, also conducted by the APhA Foundation and funded by GlaxoSmithKline, this program was aimed at implementing a patient self-management program for diabetes using community-based pharmacies as the base of operations.



The Diabetes Ten City Challenge (DTCC) consisted of 3 main objectives:



1. To implement an employer-funded, collaborative health management program using community-based pharmacist coaching, evidence-based diabetes care guidelines, and self-management strategies designed to keep patients with diabetes healthy and productive.



2. To implement the patient self-management training and assessment credential that equips patients with the knowledge, skills, and performance monitoring priorities needed to actively participate in managing their diabetes.



3. To assess participant satisfaction with overall diabetes care and pharmacist care provided in the program.



Patients in the DTCC program worked with a community pharmacist to develop their knowledge, skills, and performance related to self-management of diabetes. This unique approach established the community pharmacist as a patient coach and leader of the care team. Community pharmacists are in a prime position to serve this role, since they have so much regular contact with patients



DTCC program outcomes included statistically significant improvements in A1C, LDL cholesterol, and systolic and diastolic blood pressure measures. Patients also reported higher rates of influenza vaccinations, and being current in terms of eye and foot examinations.



In addition to improved clinical outcomes, average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Full results and more information can be found here http://www.diabetestencitychallenge.com/index.php.



The DTCC illustrates an important opportunity to shift the model of care, improve health outcomes, and lower cost. As we face a reduction in primary care physicians and an increase in the number of patients with chronic conditions, we need to work toward implementing creative and collaborative solutions to meet the needs of our citizens.

The work to improve medication safety

For more than twenty years, I have been a member of our hospital's P and T Committee---an important committee whose job, among other things, is to maintain and update the formulary AND to monitor and improve the safety of medication at all times. I have chaired a subcommittee on Medication Safety for more than a decade. Each year around this time, we issue a summary of our progress in this struggle. I would like to hit the highlights of the current summary. In this past year the team reviewed quarterly medication event and adverse drug reaction reports and made many recommendations to address key safety issues. We benchmarked our own data against national data from hospitals just like us who are members of the University Healthsystem Consortium in Chicago. In other words, we put our dirty laundry out to dry and explicitly compared our progress to a national peer group--not an easy job!! We invited national experts from the ISMP, the Institute for Safe Medication Practice ,to come inside our tent and to make specific recommendations as to how we might improve our internal control processes. We tackled some specific clinical challenges in caring for patients with a wide range of diseases including diabetes, heart disease,many types of cancers, and others. In each clinical condition, we carefully tracked medication safety from quarter to quarter and year to year. We empowered multidisciplinary teams to "tell us like it really is" and we listened closely to their reports. In a word, we spent a year of tough self evaluation---asking difficult questions and sometimes getting answers that we did not like. However, we never lost sight of the real goal---to do no harm and to improve every day. The staff involved here are the unsung day to day real heroes of hospital care. What are you doing to improve the safety of medication where you work?? DAVID NASH