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Challenges of Standardization

Challenges of Standardization. Dennis Helling, PharmD, DSc, FCCP, FASHP Executive Director Pharmacy Operations & Therapeutics Kaiser Permanente Colorado Clinical Professor University of Colorado School of Pharmacy. Incremental vs. Transformational Change.

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Challenges of Standardization

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  1. Challenges of Standardization Dennis Helling, PharmD, DSc, FCCP, FASHP Executive Director Pharmacy Operations & Therapeutics Kaiser Permanente Colorado Clinical Professor University of Colorado School of Pharmacy

  2. Incremental vs. Transformational Change • To facilitate the spread of innovation that truly transforms, it must be developed on a base of consistency and standardization.

  3. Random Variation • The level of random variation is a physical attribute of a process • Reducing random variation requires a new process with a new level of random variation, superior to the original process • Real life examples from KPCO

  4. … the Journey … an “Incubator of Innovation” Model Refinement Idea

  5. KPCO Clinical Pharmacy Services • Anticoagulation (25) Float Pool (4) Research (5) • Cardiac Risk (22) Pharmacogenomics Research Fellow • Call Center (38) Primary Care (35) Residents PGY2 (6) • Drug Information (2) Medication Safety (2) Therapeutic Initiatives • Travel Clinic (3) Specialties(23) Asthma / Allergy Hospital (1) Neurology Cardiology/Heart Failure (2) Infectious Disease Oncology (2) Continuing Care (3) Memory Clinic Palliative Care (3) Diabetes/Endocrinology Behavioral Health (3) Transplant GI Nephrology Weight Mgmt

  6. Clinical Pharmacy Cardiac Risk Service (CPCRS) • Centralized telepharmacy model with computerized tracking system • 21 clinical pharmacy specialists & 1 technician • 800-1,000 patients per clinical pharmacist • Currently manage >14,000 patients with CAD • In addition, also managing >800 patients with peripheral vascular disease (PVD) • Stroke patients 1,500

  7. CPCRS Significantly Improves Cholesterol Care • Standardizing secondary CAD prevention establishes new, more optimal, level of random variation in cholesterol care Transformational change 97% 73% 55% 26% BEFORE & AFTER: Patients Reaching Cholesterol Goal BEFORE & AFTER: Patients Screened for Cholesterol Arch Intern Med 2005;165:49-54 Am J Card 2000;85:36A-42A

  8. CPCRS Significantly Reduces Risk of Death Pharmacotherapy 2007;27(10):1370-1378

  9. Clinical Pharmacy Anticoagulation Service (CPAS) • Centralized telepharmacy service • Cares for ~8,000 patients • Staffing • 22 clinical pharmacists/specialists • 3 pharmacy technicians • ~500 patients per clinical pharmacist

  10. CPAS CPAS Results/Outcomes • Standardizing anticoagulation management establishes new, more optimal, level of random variation • 40% reduction in risk of complications Transformational change CHEST 2005;127:1515-22. J Thromb Thrombolysis 2003; 15:113-8. Arch Intern Med 2000;160:2926-32.

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  12. Challenges • Measuring and improving quality care delivery • Defining standardized quality measures • Critical to ensure apples-to-apples comparisons • Can standardization coexist with individual clinical judgment? • Demonstrating the value of clinical services

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