title: The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores.
abstract: BACKGROUND
  The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions.
  
  
  OBJECTIVE
  To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures.
  
  
  METHODS
  Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator.
  
  
  RESULTS
  A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings.
  
  
  CONCLUSIONS
  TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.
authors.affiliation: The University of Oklahoma College of Pharmacy, Pharmaceutical Sciences, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States. Electronic address: David-george@ouhsc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: George
authors.affiliation: The University of Oklahoma College of Pharmacy, Pharmaceutical Sciences, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: The University of Oklahoma College of Pharmacy, Pharmaceutical Sciences, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
authors.forename: JoLaine R
authors.initials: JR
authors.lastname: Draugalis
authors.affiliation: Kuwait University, Faculty of Public Health, Health Sciences Center, Safat, Kuwait 13110, Kuwait.
authors.forename: Eleni L
authors.initials: EL
authors.lastname: Tolma
authors.affiliation: The University of Oklahoma College of Pharmacy, Pharmaceutical Sciences, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
authors.forename: Shellie L
authors.initials: SL
authors.lastname: Keast
authors.affiliation: The University of Oklahoma College of Pharmacy, Pharmaceutical Sciences, 1110 N. Stonewall Ave., Oklahoma City, OK 73117, United States.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Wilson
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003157:Community Pharmacy Services / Q000592:standards*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D010595:Pharmacists / Q000592:standards*; D011787:Quality of Health Care; D014481:United States