Quality Assurance Methods For Medication Therapy Management

• US 20130166316A1
• Filed: 02/15/2013
• Published: 06/27/2013
• Est. Priority Date: 12/05/2007
• Status: Abandoned Application

• Current Assignee: PharmMD Solutions, LLC
• Original Assignee: PharmMD Solutions, LLC
• Inventors: Bartholomew, Samuel W. III, Hogue, Michael D., McDaniel, Scott A., Tice, Bradley P.
• Application Number:
  US13/768,904
• Publication Number:
  US 20130166316A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

A method for improving quality assurance methods for medication therapy management using a computer particularly adapted for a health care management or delivery organization is provided, the method including at least the steps of: providing a set of internal controls, wherein the internal controls further include a set of national guidelines and standards, as well as a qualified staff; and development by the qualified staff of a clinical rule based upon the national guidelines and standards. In other embodiments, a clinical quality assurance team further reviews the clinical rule developed by the staff. In further embodiments, a set of external controls is provided, wherein the external controls include one or more of a plurality of approved pharmacists, an external clinical advisory council, and/or an independent review board.

Claims

1. A method for improving quality assurance methods for medication therapy management using a computer particularly adapted for a health care management or delivery organization, wherein the method comprises the following steps:

a) providing a set of internal controls, wherein said internal controls further comprise a set of national guidelines and standards; and

a qualified staff; and

b) development by the qualified staff of a clinical rule based upon the national guidelines and standards.

2. The method of claim 1, wherein said internal controls further comprise a clinical quality assurance team, which reviews the clinical rule developed by the staff.

3. The method of claim 1, further comprising:

providing a set of external controls, wherein said external controls further comprise one or more of a plurality of approved pharmacists, an external clinical advisory council, and an independent board.

4. The method of any of claims 1-3, wherein one or more members of a set of external controls either validates a clinical rule developed by the staff, or validates a staff-developed clinical rule that has subsequently been reviewed by a quality assurance team.

5. The method of claim 3, wherein said each pharmacist comprising said plurality of approved pharmacists either received their Doctor of Pharmacy degree and completed residency training, or is board certified.

6. The method of claim 5, further comprising the step of providing documentation to the panel of approved pharmacists, and to the external clinical advisory council and independent board to support the development of a validated clinical rule.

7. The method of claim 6, wherein said validation of the clinical rule further comprises:

a) identifying a data set containing patient claims data;

b) predicting whether the clinical rule will identify patients, whose collected data comprises the patient claims data, sought to be identified;

c) running said patient claims data against said clinical rule; and

d) determining whether patients identified by the clinical rule are those predicted to be identified.

8. The method of claim 7, further comprising:

a) running patient data against a validated clinical rule, thereby identifying individual patients;

b) providing medical intervention to said identified individual patients; and

c) monitoring subsequent health benefit claims of said patients provided with medical intervention.

9. The method of claim 8, wherein said monitoring comprises comparing

a) health benefit claims of said identified individual patients before said medical intervention;

and

b) health benefit claims of said identified individual patients after said medical intervention.

10. The method of claim 8, wherein said monitoring comprises comparing

a) health benefit claims of said identified individual patients after said medical intervention;

and

b) health benefit claims of identified individual patients that have not received medical intervention.