Pharmacist-facilitated Patient Reported Outcome Measure (PROM) monitoring: developing an EHR SmartForm© to monitor side effects of oral oncolytics during routine telehealth encounters.

Purpose: Patient reported outcome measures (PROMs) are increasingly used in oncology care, but pharmacists providing direct patient care have been overlooked. We engaged pharmacists and adults receiving oral oncolytics (chemotherapy medication taken by mouth) to develop a SmartForm© in the electronic health record (EHR) for PROM monitoring. Pharmacists verbally ask the patient side effect questions during routine telehealth encounters and enter responses in real time.

Modeling package size-conscious automated dispensing cabinet replenishment to improve efficiency.

Purpose: Optimization of automated dispensing cabinets (ADCs) has traditionally focused on modifying the inventory within these devices and ignored the replenishment process itself. Rounding replenishment quantities to the nearest package size, termed package size-conscious replenishment (PSCR), was investigated as a way to optimize labor needs for ADC replenishment.

Methods: A simulation of PSCR for a subset of medications stocked in ADCs at the University of North Carolina Medical Center was conducted.

Development and assessment of an abbreviated medication regimen complexity index (the A-MRCI).

Purpose: Adaptation of the Medication Regimen Complexity Index (MRCI) for automation in an electronic medical record has the potential to improve medication optimization and patient outcomes. The purpose of this study was to develop and evaluate an abbreviated medication regimen complexity index (A-MRCI) and compare its associations with patient-level factors to those of the MRCI.

Methods: The MRCI was modified via several rounds of review with an expert panel of clinical pharmacists and outcomes researchers.

Telehealth medication management and health care spending in a Medicare Accountable Care Organization.

Value-based care is an opportunity for medication optimization services to improve medication management and reduce health care spending. The reach of these services may be extended through telehealth. However, as health care systems and payers grapple with the long-term financing of telehealth, real-world assessments are needed to evaluate the potential economic impact of pharmacy-driven telehealth services.

Impact of pharmacist participation in the patient care team on value-based health measures.

Purpose: To evaluate whether pharmacist engagement on the interdisciplinary team leads to improved performance on diabetes-related quality measures.

Methods: This was a retrospective observational study of patients seen in primary care and specialty clinics from October 2014 to October 2020. Patients were included if they had a visit with a physician, nurse practitioner, physician's assistant, or clinical pharmacist practitioner (CPP) within the study period and had a diagnosis of diabetes.

Identifying health-system pharmacy operational process categories and corresponding tasks across a diverse health system using a modified Delphi process.

Purpose: The purpose of this study was to identify and build consensus on operational tasks that occur within a health-system pharmacy.

Methods: An expert panel of 8 individuals was invited to participate in a 3-round modified Delphi process. In the first round, the expert panel independently reviewed an initial list and provided feedback.

Development of a system-wide pharmacy operational weighted workload model at a large academic health system.

Purpose: The purpose of this study is to develop a standard operational and distributional weighted workload model that is applicable across an integrated, diverse healthcare system. This model aims to not only demonstrate the operational intensity of pharmacy practice but also to inform opportunities to decrease waste, increase efficiency, facilitate growth, and demonstrate value across operational and distributional pharmacy services.

Summary: Time studies were conducted at 8 hospitals within the UNC Health system to objectively measure time spent within each operational process in order to create a system-wide weighted workload model.

Role of Pharmacy Analytics in Creating a Data-Driven Culture for Frontline Management.

The purpose of this article is to offer key recommendations based on the authors' experiences for utilizing pharmacy analytics to support moving beyond standard-of-practice operational metrics towards high impact reporting to drive day-to-day decisions for frontline leaders. There is a continuous and vast amount of data generated through all facets of a health system's daily operations, yet many data elements go unused and fail to contribute to value creation and increased performance at an organizational level. It is critical, therefore, for departments of pharmacy to identify and implement effective strategies to leverage data through robust business analytics and reporting, ensuring managers at every level are provided the information they need to support data-driven decisions and meaningful interventions in the day-to-day operations of the organization.

Formation and validation of an acute care clinical pharmacist productivity model: Part 2.

Purpose: The purpose of the project described here was to use the work outputs identified in part 1 of a 2-part research initiative to build and validate an acute care clinical pharmacist productivity model.

Methods: Following the identification of work outputs in part 1 of the project, relative weighting was assigned to all outputs based on the time intensity and complexity of each task. The number of pharmacists verifying an inpatient medication order each day was selected to represent the labor input.

Development and validation of a predictive model to predict and manage drug shortages.

Purpose: Pharmacy departments across the country are problem-solving the growing issue of drug shortages. We aim to change the drug shortage management strategy from a reactive process to a more proactive approach using predictive data analytics. By doing so, we can drive our decision-making to more efficiently manage drug shortages.

Transforming data into insight: Establishment of a pharmacy analytics and outcomes team.

Purpose: The importance of a data management strategy is increasingly necessary for demonstrating value and driving performance within pharmacy departments. Data analytics capabilities often do not match the pace of data accumulation. At our organization, the establishment of an embedded pharmacy analytics and outcomes (PAO) team has been instrumental to pharmacy services in generating and demonstrating value and proactively supporting a business intelligence strategy grounded in a data-driven culture.

Impact of medication bedside delivery program on hospital readmission rates.

Background: Since the establishment of the Hospital Readmission Reduction Program by the Centers for Medicare and Medicaid Services, reducing readmission rates has been a priority for health care institutions. Many institutions have developed services to combat high readmission rates, including bedside medication delivery programs, which have demonstrated reductions in 30-day readmission rates in patients who used these services.

Objective: To evaluate the impact of health system-based bedside medication delivery programs on readmission rates in patients at a low to moderate risk of hospital readmission.

Development and perceived value of a master's degree in health-system pharmacy administration training.

Purpose: To describe the development, format, and alumni and employer perceptions of a program combining a master of science (MS) degree with a residency in health-system pharmacy administration and leadership (HSPAL).

Summary: A multisite combined MS and HSPAL residency program was developed within the University of North Carolina at Chapel Hill Eshelman School of Pharmacy to increase leadership and management education. The program balances clinical and administrative experiences with didactic courses over 2 years.

The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment.

Objective: Coronavirus disease 2019 (COVID-19) poses societal challenges that require expeditious data and knowledge sharing. Though organizational clinical data are abundant, these are largely inaccessible to outside researchers. Statistical, machine learning, and causal analyses are most successful with large-scale data beyond what is available in any given organization.

A preliminary study of platelet hyperactivity in the chronic indeterminate phase of Chagas' disease.

The chronic indeterminate phase of Chagas' disease is asymptomatic despite positive test results for antibodies specific to Trypanosoma cruzi. CD62P-APC (P-selectin) and PAC-1 FITC (GpIIb/IIIa) may improve diagnosis as biomarkers of platelet activity. Nine asymptomatic seropositive subjects, previously untreated, were selected from a blood bank within a year of Chagas' disease detection, in addition to a control group of four.

Proton Pump Inhibitors: Risk for Myopathy?

Objective: The purpose of this article is to describe the relationship between proton pump inhibitors (PPIs) and symptoms of myopathy based on case reports.

Data Sources: A literature search was conducted in PubMed (1946 to June 2016) using MeSH terms proton pump inhibitors, omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, pantoprazole, and muscular diseases. Additionally, a search was conducted in ToxNet and EMBASE using similar search criteria.

Transitional cell carcinoma of bladder originating from transitional cell carcinoma of anus.

A unique case of transitional cell carcinoma of the bladder with the primary being in the anus is reported. The patient presented with acute urinary retention from a large bladder tumor, which was thought to be primary to the bladder. Biopsy of the bladder revealed transitional cell carcinoma, microscopically indistinguishable from the primary cloacogenic carcinoma diagnosed seven years previously.

Red cell surface antigen and its relationship to survival of patients with transitional cell carcinoma of the bladder.

We studied 73 patients with transitional cell carcinoma of the bladder seen from 1967 to 1973. The red cell antigen test was done in a controlled blind study to determine if tumor behavior can be predicted by this test. Our results do not substantiate the findings of other investigators who have reported excellent correlation.