Thanks!
Hi Emily. Great work. One qualitative measure that is worth exploring is if ED physicians value oral corticosteroids more than ICS and the impact that has on prescribing. There is a long history prescribing the former so your intervention may respond to some simple education measures focused around this issue.
Great progress on this, Emily! The main thing I would adjust this week is to use the proportion of prescriptions given and proportion of prescriptions filled as an outcome measure rather than process measure. I agree with the thoughts in class that it would be really helpful to track down the proportion of prescriptions filled through pharmacies, if possible. Great job!
Hi Emily,
Great job.
Q1: My suggestion would be to put this in table form with indicators and measurement tool being separate columns. It’ll be easier to digest. I’d also focus your efforts (for now) on the physician behavior.
Re: process indicators—I think #of trainings and attendance is great. Although I haven’t seen this described before as a process indicator, I like your idea of seeing how many times the CAB met—you might want to include WHO within the CAB met. As we discussed in class, I’d remove the ICS inhalers in the ED (since meds aren’t dispensed by EDs). You might reframe availability medications to be “number of meetings attended by pharmacy and ED staff to discuss ICS medications on formulary.”
Re: outcome indicators: Separate out how many ICD were prescribed in ED and how many prescriptions were filled. The prescription information will be in the EMR. FILLING the meds will be much harder to get. At Highland, you might have to get Medi-Cal billing records.
Q2: The real intermediate indicator here would be what you had in outcome measure: a change in provider attitudes/knowledge. If you saw prescription of ICS increasing WITHOUT this, then something else might be going on. If the prescriptions of ICS increased WITH this, you might assume that your education was effective.
Q3: For quantitative data, be sure to include the denominator here. ICD prescription rates among asthmatic patients (age x-x). Be sure to cluster by MD (we’ll get more of this next week). Re: Qualitative data: I’d focus still on providers, rather than patients, since it’s really the doctors who are not prescribing the medications (yes—there are downstream issues with filling prescriptions, but you need to go step-wise). You want to get more information about what’s getting in the way of prescribing ICS and develop means to overcome those barriers that your community identifies