The integration of quality assessment and a patient-specific intervention/outcomes program.

The clinical intervention program in place at the University of Iowa Hospitals and Clinics is based on the pharmacist's evaluation of the patient, the disease state, and the appropriateness of the selected therapy. The system was developed so that all pharmacists within our institution: staff pharmacists, clinical pharmacy specialists, clinical pharmacists, and pharmacy residents can easily and efficiently document all interactions with other health care providers. The recent introduction of the Medication Use Indicators process by the Joint Commission has provided many pharmacy departments with a series of outcome measurements which may prove useful in their attempts to maximize contributions to the medication use process. In this article, we describe how our department has begun to utilize the Joint Commission indicator data by integrating information from them into the daily practices of our staff, and how our department has utilized a formal interventions and outcomes program to evaluate such efforts.

Cost savings and avoidance from clinical interventions.

A method that lets a pharmacy department collect data on cost savings and avoidance achieved through pharmacist interventions is described. The pharmacist intervention program at an 849-bed institution is based on the pharmacist's evaluation of the patient, the disease or condition, and the appropriateness of the drug therapy selected. The pharmacist records the recommendation, the rationale, and the intervention outcome, and the data are entered into the medication order-entry system. An assigned code indicates the potential severity of consequences had the intervention not been made. The information is forwarded to the clinical interventions and financial assessment committee (CLIFAC) for analysis of cost savings and potential cost avoidance. To calculate savings, CLIFAC determines the drug acquisition and relevant laboratory costs that would have been charged, as well as the cost of a change in therapy. A method was developed that allows CLIFAC to use hospital-specific diagnosis-related-group data to determine potential cost avoidance as a function of hospital days prevented. From July 1994 through April 1995, 4648 interventions were documented by the 50-member inpatient and ambulatory care pharmacist staff and evaluated and quantified. Of these interventions, 87% were accepted by the medical staff. The accepted interventions represent a net therapy cost saving of $487,833, as well as a cost avoidance of $158,563 achieved by prevention of a potential net 371.9 additional hospital days. A pharmacy department's financial assessment committee evaluated pharmacist interventions by determining changes in the cost of therapy and estimating potential changes in the length of stay.