The National PACE Association (NPA) recently updated the PACE pharmacy performance measures, which are technical specifications pertaining to PACE participants. Of the 11 new measures, four specifically focus on quality. How will they impact PACE pharmacy services? While each of these measures are important and play a role in improving care, we’ll primarily focus on the quality measures in this article. The ultimate goal of PACE, including PACE pharmacy, is to provide participants with high-quality care that keeps them independent and active. By utilizing an interdisciplinary collaborative approach, PACE centers can maximize their outcomes by taking advantage of the valuable insight and recommendations that each member of the healthcare team can bring to the table. Let’s take a look at the new performance measures—and the role PACE pharmacy providers play in adhering to those standards.
1. Rate of Emergency Department VisitsThis measure includes all emergency visits except those to a PACE Center clinic that resulted in an inpatient admission.
- How can this impact you? By determining the rate of ER visits, centers can evaluate the quality of care participants are receiving as well as contributing factors to the visits. By evaluating the nature of the admissions, centers can identify if they were care- or medication-related and if any preventive measures could have made an impact on the number of visits.
- What can pharmacists do? As stated above, some ER visits could be medication-related, so pharmacists should monitor medication regimens to identify any possible medication issues or potential adverse events. Additionally, pharmacists should ensure that participants are on optimal medication regimens to manage their disease states and to prevent exacerbations that may also contribute to ER visits. Finally, it could be beneficial to perform a retrospective root cause analysis to help identify medication-related trends and to determine if any current protocols may need to be adjusted.
2. Advance Care PlanningThis measure takes into account the percentage of participants with documentation of advance directives.
- How can this impact you? This measure ensures that participants’ affairs are in order in the event of emergencies, which aids centers in how to direct care and to proceed as care progresses and as participant’s level of care changes. Centers should consider evaluating if participants have advance directives and paying special attention to physician orders for life-sustaining treatment (POLST) forms.
- What can pharmacists do? While pharmacists have little involvement in obtaining advanced directives and POLST forms, the information contained in these documents provides great value to the pharmacist during assessment reviews. As pharmacists actively review medication therapy regimes, consideration will be given to both the level of care and therapy wishes to ensure a participant’s medication regimen is in agreement with care plans.
3. Pressure Ulcer PrevalenceThis measure determines the prevalence of Stage III, Stage IV and unstageable pressure ulcers, both new and old, in PACE participants. However, pressure ulcers present on enrollment to the PACE program should be excluded.
- How can this impact you? By being able to evaluate the number of more severe ulcers among participants, centers can determine if ulcers are becoming a more prevalent issue. Depending on the findings, centers can ascertain if an intervention must be made pertaining to the treatment of pressure ulcers and whether preventive measures should be implemented.
- What can pharmacists do? While pharmacists do not play a direct role in wound care, they’re able to provide recommendations for barrier creams and other products that may aid in prevention and care as well as identify medications that may be hindering the healing process. Additionally, pharmacists are able to provide appropriate antibiotic recommendations if any infections related to pressure ulcers occur among participants.
4. 30-Day All Cause Acute Hospital ReadmissionThis measure is meant to evaluate the number of acute inpatient admissions to a hospital followed by another acute admission within 30 days of the initial admission involving any diagnosis.
- How can this impact you? Determining the cause of the admissions is the key to implementing ways to prevent them. Additionally, being able to differentiate if the second admission within the 30-day period was related to the initial admission or completely unrelated can help centers improve the quality of care participants receive post-discharge to help limit complications and optimize therapy. Centers may also consider revising their readmission protocols once participants return from hospitals by ensuring they are healthy enough to return and don’t require more skilled care than they did prior to their hospital admission.
- What can pharmacists do? Prior to and post-discharge, pharmacists should perform a medication reconciliation to ensure that participant medication regimens are appropriate and effective. Additionally, pharmacists should monitor participant response closely to ensure the participant is receiving adequate therapy for all disease states so as to prevent a potential readmission.