Pharmacy Quality Alliance (PQA) – December 2007 Update

By:          David P. Nau, Ph.D., R.Ph., CPHQ
Director, Practice Improvement
Pharmacy Quality Alliance (PQA)
&
Associate Professor
College of Pharmacy
Martin School of Public Policy & Administration
University of Kentucky

PQA Overview

PQA is a self-sustaining, membership-based, alliance of nearly 60 organizations.  The alliance formed in April 2006 with the mission of improving health care quality and safety through the development of pharmacy, and pharmacist, performance measures, the development of guidelines for public reporting about the safety and quality of pharmacy services, and through testing of new payment models for pharmacy services that incorporate assessments of quality.  Visit www.pqaalliance.org for more details.

Measure Development and Testing

During 2007, PQA contracted with two organizations to facilitate the development and testing of performance measures for pharmacies.  The American Institutes of Research (AIR) worked with PQA to develop and pilot-test a questionnaire to gather consumer feedback on the quality of pharmacy services.  This questionnaire was developed in accordance with the AHRQ guidelines for development of CAHPS surveys.  The CAHPS surveys are used by many public and private payers to gather consumer feedback on selected providers (e.g., hospitals, physicians, drug plans).  Pilot-testing of the questionnaire was completed in November 2007 and the questionnaire will be submitted to AHRQ for consideration as the CAHPS-Pharmacy measure within the CAHPS family of surveys.   If adopted by AHRQ, the questionnaire and technical manual will be available through AHRQ.   

PQA worked with NCQA and Advanced Pharmacy Concepts (APC) to develop and pilot-test performance measures that can be derived from drug-claims data.  The goal was to develop measure specifications that could be used by a health plan, drug plan, or other payer, to assess performance at the level of an individual pharmacy.  The measures could also be used by a network of pharmacy for quality improvement. The measures fall into one of 4 categories:  medication adherence/persistence; medication safety; medication appropriateness; and efficiency. NCQA drafted the detailed specifications for the starter set of measure concepts that were endorsed by PQA in November, 2006.   At the conclusion of pilot-testing in November 2007, NCQA identified 14 measures that it recommended for submission to the National Quality Forum (NQF) for endorsement.  

Another important development is that CMS has indicated its intention to utilize a subset of the PQA measures in evaluating the quality and safety of medication use within prescription drug plans.  During 2008, CMS will be conducting an evaluation of drug plans that participate in Medicare Part D.  In the Fall of 2008, the Medicare drug plan finder will contain reports on the quality/safety of drug plans (based partly upon the PQA-endorsed measures) so that consumers can compare drug plans based on the quality/safety of medication use by persons within the plan.  This may create an incentive for drug plans to work with community pharmacists to improve the quality/safety of medication use.

During 2008, a small number of demonstration projects will be initiated to assess the feasibility of creating a pharmacy report card that allows a pharmacy to benchmark its performance against a peer group.  PQA hopes that these projects will provide insight on the most appropriate ways to aggregate quality-related data and provide useful information to pharmacies and the public.