Date Published: January 15, 2019
Publisher: Public Library of Science
Author(s): Eldon Spackman, Fiona Clement, G. Michael Allan, Chaim M. Bell, Lise M. Bjerre, Dave F. Blackburn, Régis Blais, Glen Hazlewood, Scott Klarenbach, Lindsay E. Nicolle, Nav Persaud, Silvia Alessi-Severini, Mike Tierney, Harindra C. Wijeysundera, Braden Manns, Yan Tang.
To develop key performance indicators that evaluate the effectiveness of a prescription medication system.
A modified RAND/UCLA appropriateness method was used to develop key performance indicators (KPIs) for a prescription medication system. A broad list of potential KPIs was compiled. A multidisciplinary group composed of 21 experts rated the potential KPIs. A face-to-face meeting was held following the first rating exercise to discuss each potential KPI individually. The expert panel undertook a final rating of KPIs. The final set of KPIs were those indicators where at least 80 percent of experts rated the indicator highly i.e. rating of ≥ 7 on a scale from 1 to 9.
292 KPIs were identified from the published literature. After removing duplicates and combining similar indicators 71 KPIs were included. The final ranking resulted in six indicators being ranked 7 or higher by 80% of the respondents and an additional seven indicators being ranked 7 or higher by ≥70 but ≤80% of respondents. The six selected indicators include four specific disease areas, measure structural and process aspects of health service delivery, and assessed three of the domains of healthcare quality: efficiency, effectiveness, and safety.
These indicators are recommended as a starting point to assess the current performance of prescription medication systems. Consideration should be given to developing indicators in additional disease areas as well as indicators that measure the domains of timeliness and patient–centeredness. Future work should focus on the feasibility of measuring these indicators.
Effective prescription medication systems ensure patients can access needed medications, reduce overuse of inappropriate medications, and optimize use of cost-effective medications.[1,2] Prescription medication systems include, but extend beyond publicly funded drug plans. In many jurisdictions the prescription medication system includes physicians who prescribe medications, pharmacists that dispense and sometimes prescribe medication, the public and private prescription drug plans that provide partial or full payment for prescription medications and the patients who use prescription medications.
We used a modified RAND/UCLA appropriateness method to develop KPIs for a prescription medication system.[8–10] This method is a formal group judgment process that combines collective judgment of experts with scientific evidence, by asking panelists to rate, discuss, and then re-rate indicators. It is used extensively to assess what constitutes appropriate and necessary care within a health care system. In this modified procedure, four steps were taken: 1) Identifying published KPIs relevant to a prescription medication system; 2) Rating of KPIs by an expert panel; 3) Meeting of the expert panel to discuss and develop KPIs; and 4) A final rating of the modified list of KPIs by the expert panel. This study was approved by the ethics committee at the University of Calgary, REB16-1747.
A panel of 21 experts considered a list of 71 KPIs of a prescription medication system, and selected six indicators as being valid KPIs. The selected indicators include four specific disease areas, measure structural and process aspects of health service delivery, and assessed three of the domains of healthcare quality: efficiency, effectiveness, and safety. None of the included indicators measured health outcomes or reflected timeliness or patient–centeredness. While none of the included indicators specifically measured equity, KPI’s 3–6 in Table 2, when measured across a variety of patient subgroups would enable an assessment of equity.
A multifaceted process involving a panel of 21 experts developed and assessed KPIs of a prescription medication system. Multiple rounds of rating, conference calls and one face-to-face meeting reduced the initial list of 292 indicators to six indicators rated highly as being valid KPIs. These indicators are recommended as a starting point to assess the current performance of prescription medication systems across different jurisdictions. Consideration should be given to developing indicators in additional disease areas as well as indicators that measure the domains of timeliness and patient–centeredness. In order to understand differences–and improve performance within KPIs across jurisdictions—assessing the capacity of publicly funded medication systems will be important. Future work will focus on the feasibility of measuring these indicators.