title: Improving performance of an accountable care organization on a quality measure assessing β-blocker use in systolic heart failure.
abstract: OBJECTIVE
  The implementation and outcomes are described for a clinical pharmacist-generated initiative to improve the performance of a Medicare Pioneer accountable care organization (ACO) quality measure evaluating the percentage of patients at least 18 years of age with heart failure and a left ventricular ejection fraction (LVEF) of less than 40% who are prescribed with an evidence-based β-blocker (carvedilol, metoprolol succinate, or bisoprolol).
  
  
  CONCLUSIONS
  Atrius Health clinical pharmacists developed several educational documents to facilitate appropriate prescribing of evidence-based therapies in patients with heart failure. After educating clinicians, clinical pharmacists reviewed patient charts to determine eligibility for initiating or switching to evidence-based β-blocker therapy. Medicare Pioneer ACO patients 18-85 years of age with heart failure and a current or prior LVEF of less than 40% were reviewed. Patients had a current prescription for metoprolol tartrate, atenolol, or no β-blocker. Patients were considered ineligible if they had a documented contraindication or intolerance to β-blocker therapy or were clinically unstable. Recommendations to initiate or switch to an appropriate β-blocker were sent electronically by a clinical pharmacist to an eligible patient's treating physician before a scheduled office visit. In approximately three months, 48 patients underwent chart review by a clinical pharmacist. Performance improved by 8% after the implementation, with 82% of eligible patients achieving the quality measure in 2014-an increase from 74% in 2013.
  
  
  CONCLUSIONS
  The performance on a Medicare Pioneer ACO quality measure evaluating β-blocker use in systolic heart failure improved in a one-year period after a clinical pharmacist-generated initiative was implemented at Atrius Health practice sites.
authors.affiliation: Atrius Health, Watertown, MA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Elman
authors.affiliation: Pharmacy Practice Department, MCPHS University, Boston, MA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Zaiken
mesh_terms: D060866:Accountable Care Organizations / Q000379:methods / Q000592:standards* / Q000639:trends; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers / Q000592:standards* / Q000639:trends; D057286:Electronic Health Records / Q000592:standards / Q000639:trends; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards / Q000639:trends; D008875:Middle Aged; D010595:Pharmacists / Q000592:standards* / Q000639:trends; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards* / Q000639:trends; D014481:United States; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists