Today, basic foundational economic principles are being applied to medicine. Demands for affordable, and high-quality care is placed on physicians, nurses, pharmacists, administrators and institutions. The delivery of such quality of care at an affordable costs to an aging population residing in various settings has perhaps taken the back seat for more than we care to acknowledge.
Health economics, the term coined to couple two disciplines (health and economics) is build on two principles; cost-effectiveness and clinical-effectiveness.
To be able to measure any effectiveness, the inherent linchpin of health economics is health outcomes. And here lies the difficulties. It is not sufficient for example to claim that reduction in blood pressure (BP) or HbA1c by a certain percentage is an acceptable outcomes. Clinicians have to ask the ultimate question; for instance, if BP or HbA1c is reduced by a certain percentage, what does that mean in terms of long-term cardiovascular complications, survival of patients and quality of life (QoL). In other words, clinicians must be in-tune to the latest studies or even surveys addressing long-term effects and QoL.
However, in controlled settings such as long-term care (LTC) or skilled nursing facilities (SNF), collecting data, and trending it ultimately improves patients outcomes and can be readily accessible.
In 2010, the Center of Medicaid & Medicare Services (CMS) pursuant to the provision in the Affordable Care Act, launched best practices in nursing homes quality assurance performance indicator (QAPI). This program provides the framework for reviewing exciting policies and procedures redesigning new ones when needed, engaging the leadership team in the process, collecting data and feedbacks, designing a performance improvement and circling back with a systemic review and analysis. This structured approach to quality assurance and performance improvement must utilize established rules of engagement such as standardized care, enhancement of patient safety, management of chronic disease and preventive care.
Trend analysis in SNF or LTC is not the holly grail of patient outcomes, it is only a tool, when used in a systematic and comprehensive way, will certainly provide positive results in patient's care. Consultant pharmacists should be at the forefront of such endeavor by liaising and bridging the clinical-cost effectiveness of therapy. Hence bringing to the table clinicians and administrators.
