Development and testing of performance measures for pharmacy services.

Objective: To report on the status of the pilot work of PQA, a pharmacy quality alliance, to develop and test performance metrics of pharmacy services for use in quality improvement, benchmarking, and pay-for-performance benchmarks.

Design: Observational cohort study.

Setting: Three health plans (commercial, Medicare and Medicaid) located in the northeastern United States and one nationwide prescription drug plan.

Patients: Pharmacies of health plans with membership ranging from approximately 3,330 to nearly 1.7 million members.

Intervention: Pharmaceutical claims data for prescriptions dispensed at community pharmacies were analyzed.

Main Outcome Measures: Not applicable.

Results: The four plans had pharmacy networks ranging from 653 to 53,153 pharmacies. When using a minimum sample of 30 members per measure, less than 10% of the pharmacies within the plans' networks were evaluable for all measures except the measure of high-risk drugs in the elderly. The measure for high-risk drugs in the elderly had 6,210 evaluable pharmacies in a network of 53,153. The measures for high-risk drugs in the elderly and medication adherence appear to have the greatest potential for use as performance measures in that they show room for improvement and variation among pharmacies.

Conclusion: The ideal performance measure is relevant, scientifically sound, and feasible. Several of the measures that underwent testing possessed some, if not all, of the properties of an ideal performance measure. Strategies for aggregating data across health and drug plans may be useful for overcoming sample size challenges.