What is the PSPC?
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) is a breakthrough effort to improve the quality of health care across America by integrating evidence-based clinical pharmacy services into the care and management of high-risk, high-cost, complex patients. The PSPC is designed to spread leading practices that have been proven to improve patient safety and health outcomes. The collaborative is run on 12-month cycles; every year, teams participate in Learning Sessions, Action Periods, and listserv dialogue, and they measure, share, and track improvements as well. Expert national faculty help teams adapt, test, and implement successful practices selected from the "Change Package" -- a suite of field-tested best practices adapted from high-performing organizations.
Collaboratives use a fast-paced, iterative improvement method. The Model for Improvement -- adapted from the Institute for Healthcare Improvement (IHI) Breakthrough Collaborative Series method -- is taught at the PSPC Learning Sessions and helps teams achieve rapid change. Following each Learning Session, teams return home for Action Periods, during which they apply what they have learned using the Model for Improvement. Continuous, small-scale, rapid testing leads to adaptation of leading practices to fit local conditions.
What is the Change Package?
The Change Package details the leading practices that result in successful performance. Developed through site visits to high-performing organizations, the Change Package serves as a catalogue of the leading practices that teams will adapt in the accelerated improvement process.
What are clinical pharmacy services?
For the purposes of the Patient Safety and Clinical Pharmacy Services Collaborative, clinical pharmacy services (CPS) are defined as patient-centered services that promote the appropriate selection and utilization of medications. The objective of CPS is to optimize individual therapeutic outcomes. Clinical pharmacy services are provided by a multi-disciplinary health care team through individualized patient assessment and management. These services are best provided by a pharmacist or by another healthcare professional in collaboration with a pharmacist.
What is meant by the Primary Health Care Home?
For the purposes of the PSPC, a Primary Health Care Home is an organization that is delivering primary health care services to a defined population of patients.
Services typically included should represent the full spectrum of organizations that provide primary care services to the population of focus. The services should include care for chronic diseases, preventive and screening services, and acute care delivery in the outpatient setting, as well as health promotion services delivered through an inter-professional team. Primary health care homes may also include the delivery of the coordination of transitions for entering and exiting specialty and hospital-based care.
For the purpose of the PSPC, one member organization of each local community team should be the Primary Health Care Home for the patient population served by all proposed participating team members and would be considered the lead. The Primary Health Care Home organization should commit to tracking the information of the active patients throughout the course of the Collaborative for the entire local community team.
How does the PSPC relate to other Collaboratives?
The PSPC is a systems-level initiative that intends to focus on at least three levels: 1) patient-centered care; 2) organizational team delivery of care; and 3) community systems’ coordination of care for activities that require hand-offs to organizations outside of the primary healthcare medical home. This Collaborative is incorporating lessons learned from all of the previous Collaboratives: including the Organ Transplant Collaboratives involving hospitals and many other organizations; the HIV-AIDS Collaboratives; the Education and Health Promotion Collaboratives and other insights gained from the activities of the Workforce Development Collaborative, the Business Case Redesign Collaborative; the Prevention Collaborative; the Cancer Screening Collaborative; the Perinatal and Patient Safety Collaborative, and other collaboratives in the Health Disparities Collaboratives such as the Oral Heath Collaborative and the Depression Collaborative.
How does the PSPC fit in with the "Care Model" as used in the Health Disparities Collaboratives?
The Change Package, the individual change strategies, and the individual change concepts have been cross-walked with the Care Model so that all of the key elements of the Care Model can be found within the specific proposed activities to be tested by the Collaborative teams. Insights from a variety of other models are also included in the Change Package.
How can a team join PSPC?
Prospective teams should visit the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) website to find enrollment information.
Is the PSPC focused more on inpatient or outpatient care?
PSPC's primary focus has been to improve patient safety, improve health outcomes, and increase the integration of clinical pharmacy services in the outpatient setting. However, it is also the intent of the PSPC to coordinate and improve care transitions between the outpatient and inpatient settings. Over time, an increasing number of more inpatient-focused organizations are joining PSPC as well.
What is a "HRSA-supported organization"?
A HRSA-supported organization is any entity that receives from HRSA, either directly or indirectly, a grant or grant funds (e.g., Consolidated Health Center Program, Poison Control Center Grant Program, Rural Health Outreach Program, etc.), an NHSC (National Health Service Corp) health care provider, FTCA coverage, facility-based HPSA designation, or 340B Drug Pricing Program covered entity status. Organizations with a contract from HRSA are also considered HRSA-supported.
What is HRSA and what is its role in maintaining the safety-net?
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services and is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. HRSA envisions optimal health for all, supported by a health care system that ensures access to comprehensive, culturally competent, quality care.
In the U.S. health care system, a core safety-net provider has two defining characteristics: (1) either by legal mandate or explicitly adopted mission, they maintain an "open door," offering patients services regardless of their ability to pay; and (2) a substantial portion of their patients are uninsured, underinsured, and/or otherwise vulnerable. Examples of HRSA-supported safety net organizations include Federally Qualified Health Centers, HIV/AIDS clinics, 340B covered entities, rural health clinics, disproportionate share hospitals, and critical access hospitals. Please visit the Health Resources and Services Administration website for additional information.
What is the 340B Drug Pricing Program?
The 340B Drug Pricing Program is a Federal program that requires drug manufacturers to provide outpatient drugs to eligible health care centers, clinics, and hospitals (termed "covered entities") at a reduced price. This requirement is described in Section 340B of the Public Health Service Act, which was enacted in 1992 to provide financial relief to those facilities that provide care to the medically underserved. The 340B Drug Pricing Program is administered by HRSA's Office of Pharmacy Affairs (OPA).
In all of its activities, OPA emphasizes the importance of comprehensive pharmacy services being an integral part of primary health care. The 340B Program helps eligible safety net organizations ensure medication access, a key component of clinical pharmacy services and the continuum of care. Comprehensive pharmacy services include patient access to affordable pharmaceuticals, application of "best practices" and efficient pharmacy management, and the application of systems that improve patient outcomes through safe and effective medication use. For more information, please visit the Office of Pharmacy Affairs website.
What is the Prime Vendor Program (PVP)?
The 340B Prime Vendor Program (PVP) is managed by Apexus through a contract awarded by the Health Resources and Services Administration (HRSA), the Federal agency responsible for administering the340B Drug Pricing Program. As the contractor to the 340B Prime Vendor, Apexus is responsible for negotiating pharmaceutical pricing below the 340B price as well as improving access to affordable medications by establishing a distribution network for pharmaceuticals to covered entities. More information is available at https://www.340bpvp.com/public/default.asp.
What is the projected cost for a team to participate in the PSPC?
The estimated cost, which may vary for different organizations, is often a realignment of resources towards QI initiatives that either are already ongoing or are a high priority for the organization, resulting in increased efficiency as well as improved outcomes and safety.Travel costs to the learning Sessions will be the primary direct expense related to participation.
Travel costs include transportation and lodging for two people from each participating organization on a team. When possible, the PSPC uses technology for the learning sessions in order to minimize travel costs for the teams.
Will HRSA provide funding for teams to participate in PSPC?
HRSA is not able to contribute financially to teams participating in PSPC. However, federal grant funds to PCAs and Health Centers may be used to support quality activities, including the Patient Safety and Clinical Pharmacy Services Collaborative.
Travel costs to learning events will be the primary expense related to participation. Teams are responsible for securing their own travel and lodging resources.
Some state leadership organizations have raised money from various partners to support team travel from their particular state. Some organizations have budget line items dedicated to quality improvement or management, and they use a portion of those resources for participation in the PSPC.
How should teams allocate funds during the Patient Safety Clinical Pharmacy Services Collaborative?
One option might be to seek out partners, local, state or national foundations or donors that can provide funds for travel and other in-kind services. Some organizations have budget items dedicated to quality improvement or management and a portion of these resources might be set aside for participation in the PSPC.
Are there any plans to include distance learning to keep costs down?
When possible, the PSPC uses technology for the learning sessions in order to minimize travel costs for the teams.
Can the PSPC share examples or models of financing for participating in the PSPC?
Federal grant funds to Primary Care Associations (PCAs) and Health Centers may be used to support quality activities, including the Patient Safety and Clinical Pharmacy Services Collaborative. Travel costs to the three Learning Sessions will be the primary expense related to participation. When possible, the PSPC uses technology for the learning sessions in order to minimize travel costs for the teams. Teams work to create a funding opportunity for a few members of the team to travel to the learning sessions, as we know that teams benefit most during the face-to-face interaction with their peers.
What is the typical time commitment needed to implement the PSPC?
The typical time commitment needed is estimated to be the equivalent of approximately .5 to 1 FTE per team. This does not mean to imply that organizations have one full time person committed to the Collaborative. This allocation is often a realignment of resources towards QI initiatives that either are already ongoing or are a high priority for the organization, resulting in increased efficiency as well as improved outcomes and safety. The estimate is based on the aggregate time the team will need to do the work of the PSPC, including time participating at Learning Sessions, on monthly conference calls, and on the PSPC listserv.
What is a Learning Session?
Learning Sessions are national meetings at which all teams are convened to share best practices in an “All Teach, All Learn” environment. These Learning Sessions can take the form of in-person meetings, virtual online meetings, or a hybrid of both approaches. In a typical PSPC year, there are three Learning Sessions.
How many teams should there be in every State?
There is no limit to the number of teams from any given State. It is important that each team be developed around a population of focus, and be anchored by one organization that serves as the Primary Health Care Home for that population.
Can you provide examples of how national or State organizations are reaching out to prospective team members?
In various states, Primary Care Associations (PCAs) and other State-based organizations have been initiating activities to support the PSPC: collaborating and networking, fundraising to support local teams, coordinating satellite linkages capacities via their hospitals, and publicizing the Collaborative in an effort to mobilize teams to submit participation packages. National organizations have also been helping with fundraising commitments and with alignment of the publicity and dissemination of information about the PSPC, as well as providing subject matter expertise.
What types of organizations can join the PSPC?
The PSPC seeks to enroll highly committed community teams made up of members from multiple organizations that serve a defined patient population. Traditionally, teams should include at least one HRSA-supported organization (e.g. Federally Qualified Health Centers, HIV/AIDS clinics, 340B covered entities, rural health clinics, disproportionate share hospitals, critical access hospitals) and ideally additional partners who together serve the defined patient population.
Other participating organizations can include hospitals; entities that provide pharmacy services; HIV/AIDS and women's health service organizations; State and local health departments; social services, mental health, and home health care providers; colleges or schools of pharmacy; and others as appropriate in the service delivery area.
Can statewide organizations (e.g. PCA, PCO, Hospital Associations) pull together a team that serves as an umbrella team for the rest of the teams from across a given State?
Yes, as long as the team includes a HRSA-supported organization that cares for the defined population of focus along with the other participant organizations as appropriate.
Can a tertiary hospital participate as team member?
What will be the role of each member of the team?
Optimally, each participating organization on a team would designate a minimum of two Travel Team members. One Travel Team member from each organization should be from a direct patient care health care team, the other from a level of organizational management and leadership responsible for systems change and improvement. The Travel Team can consist up to eight members including primary care clinicians, clinical pharmacists, and others as appropriate for the team configuration. All of the members of this Travel Team will be expected to attend all the Collaborative Learning Sessions and participate in monthly conference calls.
For the Travel Team members, how much traveling is involved?
There will be a total of three Learning Sessions. When possible, the PSPC uses technology for the learning sessions in order to minimize travel costs for the teams. Teams work to create a funding opportunity for a few members of the team to travel to the learning sessions, as we know that teams benefit most during the face-to-face interaction with their peers.
How many people should there be on a team? Are there a minimum and maximum number of members?
There is no minimum or maximum number of team members. Teams have different numbers of team members depending on the number of organizations participating on the team. Teams should include at least one HRSA-supported organization and ideally would include additional partners who together serve that defined patient population or population of focus. Although there is no minimum number of organizations is needed to form a team, providers are strongly encouraged to team with at least one additional organization.
How can I best use the team enrollment period to establish the best team?
Consider which provider organizations in your community interact with the population selected for focus. Share information about the Collaborative with these organizations, and ask if they would like to participate and in what capacity.
What should be the composition of the team?
A team should include primary care clinicians, quality improvement staff, administrators, and ideally pharmacists who provide clinical services.
HRSA encourages the entire team to be actively engaged in implementing the Patient Safety and Clinical Pharmacy Services Collaborative in their respective organizations. This is a true team effort which cannot be passed on to one person to manage or supervise. Each team member will be contributing individual abilities, contacts, networks, perspective, and expertise at various times during the 12-month collaborative year.
How will the role of team leader differ from a team member?
The team leader will organize the team to accomplish the aims that all agree to address, and be responsible for seeing that monthly reporting requirements are completed. One person from each organization should serve as the day-to-day team leader and another should serve as the "systems" leader. The full Collaborative team would consist of the Travel Team plus the other team members who will not be traveling to the Learning Sessions.
What will be the role and responsibility of the team as a whole?
Together, the entire team will review, test, and implement changes developed from the PSPC Change Package that impact their systems to improve patient safety, clinical pharmacy services, and health care outcomes. The team will share responsibility appropriately in the adapting and testing of changes and developing the quantitative and qualitative reports. It is expected that additional team members will be engaged at the home organizations in support of the work of the team. Please refer to the Participation Package (located on the PSPC website) for additional team configuration details.
What is a Population of Focus (PoF)?
The population of focus (PoF) is the panel of patients the team selects to track and manage improvement. The PoF is usually organized based on a specific health marker. Patients are enrolled into a PoF once the team chooses to give them clinical pharmacy services and track their progress during the PSPC year.
What are Adverse Drug Events (ADEs) and Potential Adverse Drug Events (pADEs)?
In addition to improving patients’ health, PSPC teams also produce improvements in two patient safety categories: 1) adverse drug events (ADEs), defined as events that result in harm or injury to the patient; and 2) potential adverse drug events (pADEs), defined as medication errors that were identified and stopped with appropriate interventions before harming the patient, sometimes known as “near misses.” The term potential adverse drug event (pADE) is viewed as crisis averted, in contrast to Adverse Drug Event (ADE), which causes harm to a patient, but could have been avoided.
What does it mean for a team to scale up and spread its clinical pharmacy services?
As teams improve their capabilities and management of their population of focus, we expect them to scale up and spread their services to reach additional high-risk patients. For example, a team with a PoF of diabetes patients can scale up their services to reach additional diabetes patients. The team can also spread their services to additional PoFs of high-risk patients that can benefit from CPS, such as anticoagulation patients and asthma patients. Ideally, the team will eventually scale up and spread to reach its total patient population.