HRSA PSPC: Improving Drug Safety Among High-Risk Patients

HRSA PSPC: Improving Drug Safety Among High-Risk Patients

For patients who are required to juggle multiple medications, see multiple providers and/or battle multiple chronic illnesses, medication management is an ongoing challenge. Due to the complex nature of high-risk patients’ cases, many of them are falling through the cracks. Medical errors stemming from this population cost the health care system billions of dollars annually, so addressing these needs is critical.

The Health Resources and Services Administration’s (HRSA) Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) was developed to enhance patient safety by improving care coordination related to multiple medication use by high-risk patients. PSPC, now in its fourth year (PSPC 4.0), is a continually growing action-learning program involving several hundred communities nationwide. These communities are working together in a disciplined, focused process to enhance the ability of the health care safety net to deliver safe care that produces optimal health outcomes for high-risk patient groups.  “This model is patient-centered, driven by inter-professional teams and supported by systems of partnerships,” said Linda Kwon, PSPC 4.0 Co-Director in HRSA’s Office of Pharmacy Affairs.

Adapting a Proven Model to Address Drug Safety

PSPC adapted the Institute for Healthcare Improvement’s (IHI) Breakthrough Series Collaborative Model, which involves learning sessions that alternate with action periods, and which results in rapid changes and significant outcomes. The PSPC model focuses on best practices in monitoring for adverse drug events.

PSPC built a menu of best practices – known as a Change Package – by gathering information during site visits to more than 34 high-performing health care organizations to learn about their successful integration of clinical pharmacy services with patient care.

According to Kwon, based on the findings from the site visits and through literature review, five main strategy areas for the PSPC learning and action model were identified:

• Leadership Commitment
• Measurable Improvement
• Integrated Care Delivery
• Safe Medication Use Systems
• Patient-Centered Care

Each of these areas has its own change concepts and action items, which many HRSA PSPC community teams find helpful as a foundation for their work.

Integrating a National Learning and Action Model for Rapid Change

PSPC community-based teams and partners are convened nationally at three learning sessions, which highlight the progress made by teams and provide an environment to accelerate learning and sharing by all. Between each of the learning sessions are action periods, during which teams test changes and try to learn from small improvements to systems and processes. With leadership and expertise from national PSPC faculty (field experts), HRSA also conducts periodic webinars to help teams progress through the collaborative year and to promote team development and support. “We have a diverse group of faculty members joining us for PSPC 4.0, who all bring unique strengths, passion and commitment to helping our teams deliver safer and more effective care for our patients,” says Kwon. The key to PSPC’s success is learning together, with everyone focusing on what’s working and spreading successes to other communities.

When PSPC started four years ago, 68 community-based teams participated. In the collaborative’s third year, nearly 130 teams and more than 300 partner organizations joined with PSPC in this national quality improvement effort. Just as the number of teams has grown over the years, the number of national professional organizations committed to the work has increased. The PSPC Leadership Coordinating Council comprises more than 100 national professional organizations that are committed to enhancing and spreading PSPC’s work. In 2010, the Patient Safety and Clinical Pharmacy Services Collaborative Alliance (the “Alliance”) formed as a nonprofit corporation, with leadership from several professional organizations with a vested interest in safe and effective use of medications in the U.S. The Alliance is actively engaged in expanding its partnerships to other stakeholders who share this vision and see the PSPC as a vehicle for enhancing medication use in the United States.

Partnering with the QIO Program in PSPC 4.0

To spread rapid change and reach Medicare, Medicare Advantage and dually eligible beneficiaries, HRSA PSPC is partnering with the QIO Program in PSPC 4.0. This partnership will help to improve health outcomes and patient safety in the targeted patient groups, as well as improve processes of transitions of care.  

Kwon said, “We’re excited to be partnering with QIOs and to learn how they can help make a significant impact at the state and community level.  We encourage them and other health care stakeholders to get involved in this quality improvement work. We believe that with everyone’s support, by the year 2015, we can reach our goal of 3,000+ communities that have better integrated pharmacy services and primary care, which assures optimal health outcomes and safety for our patients.”