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ACCP Report - June 2016

Highlights from the CMM Effectiveness and Implementation Grant: A Report from the Study Team


Each quarter, the ACCP Report features a column written by the CMM Effectiveness and Implementation Grant study team to provide ACCP members with highlights and learnings from the comprehensive medication management (CMM) project. In the March ACCP Report, the study team provided the first grant update since the project was launched in January 2016 (http://www.accp.com/docs/report/0316.pdf).

We continue to make progress. As mentioned in the first update, we have affirmed the interest of our 44 sites in participating in the study, and they are eager to get started. We are still awaiting IRB approval, which has slowed our efforts, but we expect to receive approval by mid-June. We are planning a kickoff webinar with the study sites in late June. Simultaneously, we will seek informed consent from the lead clinical pharmacist at each study site as well as affirm the commitment of both the clinical pharmacist and the medical director at each study site to engage in the study. Once all pharmacists have consented and sites have been confirmed, we will launch aim 1.

As a reminder, the study aims are as follows:

  • Aim 1: Assess baseline demographics, the state of CMM within each practice, and practitioner and organizational capacity for CMM service development, refinement, and expansion.
  • Aim 2: Determine best practices in the design and delivery of CMM in primary care that optimize medication use (i.e., how CMM is best delivered to patients in primary care).
  • Aim 3: Determine the structural and system-level elements (i.e., the practice management system) that are needed to support the effective and efficient delivery of CMM, and establish initial benchmarks for practice quality and efficiency.
  • Aim 4: Determine the key performance measures that support the value proposition for CMM from the perspective of stakeholders internal and external to the providing organization, and evaluate the performance of study sites according to these key measures.
  • Aim 5: Accelerate the adoption of CMM best practices through (1) replication across the 44 study sites; (2) dissemination across a facilitated community of learning to primary care practices throughout the United States; and (3) development and dissemination of the business case to key stakeholders.

To accomplish aim 1, we will conduct a baseline survey of the study sites in July. This survey will enable us to describe each site in greater detail as well as gain insight into the state of CMM within each practice. Our goal is on target, as originally planned, to have baseline findings collected, analyzed, and available this summer. As a follow-up to the baseline survey, we will conduct an interview with all sites this summer to learn more about their CMM practice model, their capacity for CMM service development and refinement, and the practice management system that supports CMM delivery. Plans for the survey and interview have been finalized and should soon be under way.

In addition to operationalizing the plans for aim 1, we have been developing our scope of work, our resources, and a timeline to launch the rapid-cycle testing of CMM within the primary care medical practices, which is at the core of aims 2 and 3. As stated in the March ACCP Report, we believe that we have a tremendous opportunity to advance the role of implementation science as an important area of research in pharmacy practice. We are committed to collaborating with a multidisciplinary team of key thought leaders and implementation scientists to ensure that we conduct this work with the highest degree of scientific rigor. To that end, these efforts are being planned in partnership with our colleagues Caryn Ward, Ph.D., and Dean Fixsen, Ph.D., with the National Implementation Research Network. We are also fortunate to be working with the American Academy of Family Physicians National Research Network (AAFP NRN), which has experience in using implementation science in primary care. To guide our implementation science efforts, we are applying the Active Implementation Frameworks (http://implementation.fpg.unc.edu/module-1) and plan to launch the first cycle in late summer.

With the operational aspects of the study under way to facilitate our launch, we continue to work toward building key organizational and individual stakeholder collaborations to maximize our impact. We have finalized the goals of our CMM Grant Steering Committee as well as our Payer Advisory Board and are in the process of reaching out to prospective members to seek their interest in serving on these important groups.

To identify best practices in CMM delivery (aims 2 and 3), the evidence base to support CMM must be present (aim 4). Our goal is to both critically examine how to implement CMM in busy medical practices to facilitate uptake and scalability in routine health care practice and, of equal importance, demonstrate the impact of CMM on the “key metrics that matter” in advancing CMM as a significant component of value-based care delivery and payment reform. Jen Carroll, M.D., MPH, and Wilson Pace, M.D., with AAFP NRN and the DARTNet Institute, respectively, have been instrumental in leading this effort and guiding our team through a series of discussions and planning meetings to solidify our key research questions and identify the key metrics of focus. Our CMM Grant Steering Committee as well as our Payer Advisory Board will also play a key role in refining our approach to aim 4.

On behalf of the investigators and study personnel, we hope these highlights are informative. Please feel free to reach out to Mary Roth McClurg at mroth@unc.edu or Todd Sorensen at soren042@umn.edu at any time with questions or insights.