Fellowship awards from the University of California will allow UC Davis Health System researchers to pursue projects to strengthen medical teams' responses to adverse clinical incidents and medical errors, and to enable pharmacies at UC medical centers to dispense a larger proportion of their patients' specialty pharmaceuticals.
The UC Center for Health Quality and Innovation awarded the fellowships to JoAnne Natale, associate professor of clinical pediatrics, and John Grubbs, director of pharmacy at UC Davis Medical Center. Launched in October 2010, the center supports and nurtures innovations at UC medical center campuses and hospitals to improve the quality, access and value in the delivery of health care.
Creating an environment to improve safety
Natale, who also is medical director of the UC Davis pediatric intensive care unit, received a fellowship to establish an interprofessional "Collaborative Incident Response Team" (CIRT) to strengthen the response of medical teams to adverse clinical events and errors that do not meet the criteria for being "sentinel" events, such as medication errors. These events can lead to patient and family dissatisfaction, increase staff stress, and higher cost settlements.
Natale said, "Although hospital personnel conscientiously strive to prevent adverse incidents from occurring, when they do, the health-care team often has difficulty discussing them transparently and in a timely manner with families."
At UC Davis Medical Center, Natale will assemble the interprofessional CIRT to pilot effective responses to adverse events. The team will help frontline staff disclose unanticipated clinical incidents and medical errors, and collect and report timely information needed to rapidly recognize and improve ways to prevent them. The CIRT will include physicians, nurses, Risk Management representatives and psychologists. Together, they can support medical teams in identifying appropriate responses when adverse incidents occur.
Bringing a trained, interprofessional team to the scene of an unanticipated adverse clinical event will create an environment that improves safety, Natale said.
Improving patients' access to specialty pharmaceuticals
With his fellowship, Grubbs will develop a program that ultimately will lead to all UC medical centers dispensing a larger proportion of their patients' specialty pharmaceuticals. Specialty pharmaceuticals are drugs and biologics used to treat complex and chronic diseases, such as autoimmune disorders, multiple sclerosis, cancer and pulmonary hypertension. They are expensive, costing on average more than $2,000 per prescription. These medications are difficult to administer, require patient training and ongoing monitoring, and have special shipping and handling requirements.
As a result, five for-profit companies control about 60 percent of the $75 billion annual market for specialty pharmaceuticals. These specialty pharmacies have built their market share through exclusive agreements with third-party payers, secured by promoting the benefits of one-stop shopping, pricing leverage and care coordination. This lack of access to payer contracts has largely excluded UC medical centers from this market. As a result, UC medical centers lack well-established outpatient specialty pharmacy programs and typically dispense a small proportion of their patients' specialty pharmaceuticals.
UC medical centers' reliance on non-UC pharmacies to provide specialty pharmaceuticals contributes to fragmentation of care, and patient and provider dissatisfaction, Grubbs said.
UC Davis Medical Center's pharmacy is distinct from its UC counterparts through its provision of care to about 25,000 patients enrolled in the Western Health Advantage (WHA) managed care program. The pharmacy, in coordination with UC Davis Health System's Managed Care Department and Managed Care Contracting, as well as health-care providers, serves as the specialty pharmacy for the WHA patients.
According to Grubbs, anecdotal evidence suggests that the arrangement has improved care coordination and patient satisfaction. He said many non-WHA patients have experienced delays with their therapy while waiting for external, for-profit pharmacies to ship specialty pharmaceuticals to them, or because of problems receiving prior authorization for treatment. These problems largely have been avoided by WHA patients, who receive their specialty pharmaceuticals from the UC Davis pharmacy, and whose insurance authorization is processed by UC Davis staff.
Based on the experience of the UC Davis specialty pharmacy, Grubbs estimates that an expansion of the practice to other UC medical centers would significantly improve the coordination and quality of care for their patients. Grubbs also estimates that each enrolled patient would generate additional revenue for UC medical centers.
Grubbs' project initially will expand the UC Davis specialty pharmacy to one or more additional payers at UC Davis Medical Center. Based on the experiences and lessons learned from this process, the program will be expanded to other UC medical centers, culminating in the development of a UC system-wide specialty pharmacy program.