chapter 9.ppt

CHAPTER 9

OUTCOMES EVALUATION OF PHARMACY OPERATIONS

Created by:Arlene B. AguilaCielo Aeb Quintia

Learning ObjectivesDiscuss the different facets of the ECHO model and their application to evaluating existing and proposed pharmacy goods, services and operations.Describe differences among five types of economic analyses as tools for managerial decision-making.List the advantages and disadvantages of the various methods of measuring humanistic outcomes, and describe the role that humanistic outcomes play in evaluating goods, services, and operations.

Identify the objectives of a service and determine the types of outcomes a pharmacists would need to measure in a pharmacy-related service.Identify the advantages and disadvantages of the various methods used to collect data when evaluating services.List and describe the uses of various outcomes evaluations and assessment.

INTRODUCTIONPharmacists make many contributions that improvethe lives of their patients on a daily basis. These contribution as range from catching a drug interaction, counseling a patient about his or her medication, or evenproviding a new value-added .While many pharmacists would like to offer these value-added services to their patients, they can have upfront costs that cannot be ignored. How can pharmacists provide these services and show that they both help their patients and actually decrease the overall cost of care? Many studies have been conducted that show that pharmacists can make a difference both in cost and in the quality of their patients lives.Pharmacists to improve the lives of their patients or customers in day to day lives.

Framing QuestionsHow does one start documenting the value of a pharmacy service? FIRST STEP: Define the problem or research question being addressed. Stating the problem upfront seems rather obvious, but it is not always done. Many pharmacists waste time and energy trying to answer poorly defined questions. .

SECOND STEP: Define the Objectives. After the problem has been stated, the next step is to define the objectives. A very broad problem will result in broadly defined objectives. On the other hand, if the problem is addressed more narrowly, a more narrowly defined objective could be studied..

THIRD STEP: Establish a framework to evaluate the question.When establishing the framework, pharmacists need to know some basic facts about the programs and diseases they are studying. Pharmacists undertaking these projects first should prioritize their objectives by determining what interventions and outcomes most need to be evaluated.

SELECTING THE VARIABLES TO MEASUREMany health care organizations make the mistake of focusing on only one area of health care when trying to reduce the overall cost of health care. Evaluating the cost of a single aspect of patient care in isolation from all other aspects is commonly known as component management.

Example of component management include focusing on the costs of drugs or laboratory tests without looking at the impact of these costs on overall health care costs or outcomes. Unfortunately, many healthstudies have focused on just one type of cost withoutconsidering the overall care of patients.

Disease management strives to consider all individual components of health care for a specific disease with a view toward an outcome that is important for successful management of that disease. Instead of dealing with one element at a time (such as prescription costs only), disease management attempts to control the disease by integrating the components of health care to provide the best total patient outcomes at the most reasonable cost.

IDENTIFYING CONFOUNDING VARIABLES THAT CAN AFFECT OUTCOMESAfter identifying a research question, study objectives, and variables to evaluate, researchers also need to think about other variables that may affect the results of the study. Any variable that also may have an impact on the results of study but is not one of the primary variables being evaluated is known as a confounding variable.

ECHO MODELOutcomes research is defined as studies that attempt to identify, measure, and evaluate the end results of health care services. Outcomes research may evaluate not only the clinical effects of health care services but also the economic and humanistic impact of these services. E- conomicC- linicalH- umanisticO- utcomes

ECHO MODELMany have proposed that evaluation of drug therapy and pharmacists value-added services should include assessments of economic, clinical, and humanistic outcomes. The economic, clinical, and humanistic outcomes (ECHO) model assumes that the outcomes of medical care can be classified along the three dimensions of economic, clinical, and humanistic outcomesE- conomicC- linicalH- umanisticO- utcomes

ECHO MODEL Economic outcomes are defined as the direct, indirect, and intangible costs compared with the consequences of medical treatment alternatives Clinical outcomes are defined as medical events that occur as a result of disease or treatment. Humanistic outcomes are defined as the consequences of disease or treatment on patient functional status or quality of life. All three of these outcomes need to be balanced simultaneously to assess value.

E- conomicC- linicalH- umanisticO- utcomes

EconomicOutcomesTraditional cost-containment measures are not always consistent with improved patient care. Thus attention has turned toward demonstrating the value of health care. A full evaluation of relevant costs and consequences differentiates outcomes research from traditional cost-containment strategies.

EconomicOutcomesCosts are defined as the value of the resources consumed by a program or treatment alternative.Direct costs are the resources consumed in the prevention, detection, or treatment of a disease or illness. These costs can be divided into direct medical and direct nonmedical costs. Direct medical costs are specific monetary transactions associated with paying for medical care, such as hospitalizations, drugs, medical supplies, and physician visits. Direct nonmedical costs involve monetary transactions for required items or services that do not involve purchase of medical care. Examples include transportation to medical facilities, special foods, and the time that family members miss work to care for others.

EconomicOutcomesIndirect costs are the costs that result from morbidity and mortality. These costs are related to changes in work production, such as costs incurred from missing work (absenteeism), costs incurred from decreased productivity despite presence at work (presenteeism), or costs incurred owing to premature death. Intangible costs are the costs incurred that represent nonfinancial outcomes of disease and medical care and are not expressed in monetary terms. These include pain, suffering, and grief.Consequences are defined as the effects, outputs, and outcomes of the program or treatment alternative

Types of Economic EvaluationThe basic task of economic evaluations is to identify, measure, value, and compare the costs and consequences of the alternatives being considered. Five types of economic analyses can be used to examine treatment alternatives: cost of illness cost-minimization analysiscost-benefit analysiscost-effectiveness analysis, and cost-utility analysis

Types of Economic AnalysesCOST OF ILLNESSinvolves identifying all the direct and indirect costs of a particular disease or illness from a particular perspective (e.g., patient, payer, or society). This method, often referred to as burden of illness, results in a total cost of a disease that can be compared with the cost of implementing a prevention or treatment strategy.

Types of Economic AnalysesCOST-MINIMIZATION ANALYSISis a tool used to compare two or more treatment alternatives that are assumed to be equal in efficacy. It simply compares the direct and indirect costs of treatment alternatives in dollars and does not consider the outcomes of the treatments (because they are assumed to be the same).

Types of Economic AnalysesCOST-BENEFIT ANALYSISis used when the outcome can be expressed in monetary terms, such as in the amount of money an HMO might save if it implements a new program. The direct and indirect costs of a program or intervention are measured as they occur.

Types of Economic AnalysesCOST-EFFECTIVENESS ANALYSISis used when the treatment alternatives are not therapeutically equivalent or when outcomes cannot be expressed in monetary units. Cost-effectiveness analysis allows researchers to summarize the health benefit and resources used by two or more competing programs so that policymakers can choose among them.

Types of Economic AnalysesCOST-UTILITY ANALYSISis used when quality of life is the most important outcome being examined. This is common in disease states in which how one feels or what one can do is more important than a clinical laboratory value or economic outcome (e.g., chronic diseases such as heart disease, diabetes, arthritis, cancer, or HIV/AIDS).

Uses of Economic OutcomesMany benefits can be realized by applying pharmacoeconomic principles and methods to evaluating pharmacy services. Economic assessments can assist in balancing cost and outcome when determining the most efficient use of health care goods and services. Economic assessments are helpful in optimizing clinical decision making.

Uses of Economic OutcomesDecision analysis is a technique used in economic evaluations to structure the logical and chronologic order of the analysis. It is a systematic, quantitative method of describing clinical problems, identifying possible courses of action, assessing the probability and value of outcomes, and making a calculation to select the optimal course of action. A tool used in decision analysis is a decision table or decision tree. A decision tree, will be shown in next slide,

Decision Treeallows researchers to display graphically all treatment alternatives being compared, the relevant outcomes associated with these alternatives, and the probabilities of these outcomes occurring in a patient population.

Uses of Economic OutcomesIn economic evaluations, there is a need to make assumptions about the variables in the analysis. It is important to keep in mind that assumptions are simply predictions about what a researcher thinks might happen as a result of a program or intervention. To account for the variety of outcomes that may arise in any intervention, researchers should use a technique known as sensitivity analysis.Sensitivity analysis is a tool that teststhe robustness or strength of economic evaluation results and conclusions by making different assumptions about outcomes over a range of plausible results.

ClinicalOutcomesTo health care professionals, the most obvious variables that should be addressed when evaluating any medical intervention are the clinical outcomes. Any value-added service can assert that patients will receive better care if given that service. Clinical outcomes vary with each disease state but should include any pertinent medications

HumanisticOutcomesQuality of life refers to an evaluation of all aspects of our lives, including where we live, how we live, how we play, and how we work. Health-related quality of life (HRQoL) encompasses only those aspects of life which are dominated or influenced significantly by personal health or activities performed to maintain or improve health.

Economic EvaluationCosts of goods and services seem intuitively simple to quantify. However, a number of potentially complicated issues must be considered. When identifying the goods or services, will the actual cost (wholesale cost) to the pharmacy or health care organization be measured, or will the charge to the patient or payer (retail cost) be measured? Sometimes access to cost data may be limited, or the data may be entirely unavailable.

Clinical EvaluationPharmacists have the ability to assess patients for general signs and symptoms of many disease states. In many states, pharmacists are also able to check blood glucose and lipid levels. They are able to measure peak flows in pulmonary patients and can assess minor skin abnormalities and wound care. All these clinical variablesmay be recorded at baseline and at each subsequent visit to chart changes and/or improvements in the patients condition

HumanisticEvaluationHumanistic outcomes generally are obtained directly from patients in the form of standardized questionnaires. There are two steps when collecting humanistic information. First is to identify the best and most appropriate survey or surveys to use (general or specific), and second is to decide how to administer the HRQoL instruments or surveys. Usually, clinicians and/or researchers choose both general and specific HRQoL instruments so that all elements related to a patients quality of life are covered in the study.

HumanisticEvaluation A patient satisfaction survey that has been used in a similar setting also may be administered. Clearly, the more information gathered, the more complete the picture will be. However, beware of respondent burden, or the time and energy it takes patients to complete the group of surveys.

Data AssessmentAfter the data collection is completed, the data must be analyzed and assessed to interpret the results andreach meaningful conclusions.

Baseline data Prior to implementing the intervention, demographic, clinical, and humanistic information should have been collected.

Uses Of Outcomes Evaluation Assessment of success or failure of a program or serviceContributing to the quality improvement programsDevelopment of additional servicesReassessing the service objectives

The End of our Report !!! Thank you for ListeningCreated by:Arlene B. Aguila

Cielo Abie Quintia

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