Applying managed care performance measures in community pharmacy-based outcomes research.
OBJECTIVE
(1) To introduce the National Committee on Quality Assurance's (NCQA's) Health Employer Data and Information Set (HEDIS), a set of managed care performance measures, as a tool for conducting outcomes research in the community pharmacy; (2) To demonstrate the practical application of this tool by describing three outcomes research projects conducted in an independent community pharmacy.


METHODS
Review of three outcomes research projects based on HEDIS: (1) Increasing ACEI Use in Patients with Heart Failure, (2) Cardiovascular Telepharmacy Project, and (3) Pediatric Antibiotic Callback Program.


METHODS
Independent community pharmacy.


RESULTS
The "Effectiveness of Care" section of HEDIS was a practical tool for designing outcomes research projects in the community setting. Improved clinical and/or service outcomes were observed in two of the projects. The challenges faced in these projects were due to the methods of implementation, rather than to the HEDIS tool itself. These projects led to a number of "lessons learned" in the conduct of outcomes research in the community pharmacy setting.


CONCLUSIONS
Community pharmacists can use NCQA's HEDIS as a tool to help gain acceptance of and reimbursement for pharmaceutical services through the formulation of outcomes projects that are of interest to managed care organizations (MCOs) seeking accreditation status. As pharmacists report their successes to MCOs, they may be better equipped to develop reimbursement strategies for services from MCOs through their demonstration of shared goals.
Capó
K M
KM
College of Pharmacy, University of Cincinnati, OH 45267-0004, USA. kristina.capo@uc.edu
Rutledge
D R
DR
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000628:therapy; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D010594:Pharmacies / Q000592:standards*; D012051:Reimbursement Mechanisms; D017216:Telemedicine / Q000379:methods; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D000900:Anti-Bacterial Agents