challenges of standardization
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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. - PowerPoint PPT PresentationTRANSCRIPT
Challenges of Standardization
Dennis Helling, PharmD, DSc, FCCP, FASHPExecutive Director Pharmacy Operations & TherapeuticsKaiser Permanente ColoradoClinical ProfessorUniversity of Colorado School of Pharmacy
Incremental vs. Transformational Change
To facilitate the spread of innovation that truly transforms, it must be developed on
a base of consistency and standardization.
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
KPCO Clinical Pharmacy Services
Anticoagulation (25) Float Pool (4) Research (5)Cardiac Risk (22) Pharmacogenomics Research FellowCall 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
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
CPCRS Significantly Improves Cholesterol Care
•Standardizing secondary CAD prevention establishes new, more optimal, level of random variation in cholesterol care 0
20
40
60
80
100
120
1 2BEFORE & AFTER: Patients Reaching Cholesterol Goal
BEFORE & AFTER: Patients Screened for Cholesterol
26%
73%
55%
97%
Arch Intern Med 2005;165:49-54 Am J Card 2000;85:36A-42A
Transformational change
Early intervention
(< 90 days post-event)
Any intervention
All-cause mortality
89% reduction 76% reduction
Cardiac-related mortality
88% reduction 73% reduction
CPCRS Significantly Reduces Risk of Death
Pharmacotherapy 2007;27(10):1370-1378
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
CPAS Results/Outcomes
CHEST 2005;127:1515-22. J Thromb Thrombolysis 2003; 15:113-8. Arch Intern Med 2000;160:2926-32.
3.3%
63.5%
5.2%
55.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Complications INR Control
CPAS Usual Care
CPAS
•Standardizing anticoagulation management establishes new, more optimal, level of random variation
•40% reduction in risk of complications
Transformational change