Pharmaceutical outcomes performance measures

Performance measures, or indicators, are frequently used to measure and compare pharmaceutical outcomes. Performance measures are used to monitor and evaluate important governance, management, clinical, and support functions that affect patient outcomes.A performance measure can be used in one of three ways to warn of potential quality problems, to measure the result of process improvement, and to monitor continuing performance.They are typically expressed as ratios. 

Some of the more common performance measurement systems used to assess pharmaceutical outcomes include report cards, balanced scorecards, clinical value compasses, profiling, performance-based evaluation systems, and others. The goals of pharmaceutical performance measurement systems are to 1) compare treatment modalities fairly 2) recognize and promote good care 3) identify and eliminate substandard care and 4) improve the level of care overall.Because performance measures can include data over the course of treatment, the outcomes of alternative therapies and practices may be detected. The end goal of any performance measurement system should not be cost containment only improving patient outcomes must be a primary concern, keeping in mind the cost effectiveness of the therapy and sustainability of the system. 

Pharmaceutical outcome data are also used to improve the quality of care, identify potential problems, and improve patient outcomes. These data are often used within a continuous quality improvement (CQI) cycle, where rate-based performance measures are tracked over time and used in conjunction with control charts to show changes in quality and assess the impact of programs or changes in process. Information can be fed back to front line health care practitioners, areas for possible improvement identified, appropriate changes made, and reassessments initiated. 

The United States has several major performance measurement systems in place. Two of the most important systems are those directed by the National Committee for Quality Assurance (NCQA) for managed care organization (MCO) accreditation and The Joint Commission on Accreditation in Healthcare Organizations (JCAHO) for health care organization accreditation. Both NCQA s performance measurement system, HEDIS, and JCAHO s IMSystem include several pharmaceutical outcomes indicators. 

David Eddy at Duke University has written extensively on the problems and potential solutions related to pharmaceutical performance measurement systems. According to a U.S. survey, the most commonly perceived problems with pharmaceutical performance measurement systems are limitations with billing and administrative databases, lack of time to review summary data by physicians, and incomplete data. Other limitations include risk adjustment (what if my practice has sicker patients), overreliance on administrative (claims) data rather than clinical data (therefore lacking key patient outcomes), patient individuality and variation in medical practice, and lack of capacity for taking into account a discipline-specific rather than a whole programs-oriented CQI approach. There has also been some debate on the reliability of performance measurement systems to assess the true impact of physician care on the quality of health care.t ... 

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