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Preventable drug-related morbidity in older adults 1. Indicator development
Neil J Mackinnon1, Charles D Hepler
1College of Pharmacy, School of Health Services Administration, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada. neil.mackinnon@dal.ca
Objective:
To develop viable clinical indicators of preventable drug-related morbidity (PDRM) in older adults.
Methods:
A survey was constructed, listing the clinical outcome and pattern of care related to a number of possible PDRMs in older adults. Using the Delphi technique, a geriatric medicine expert panel of 6 physicians and one clinical pharmacist from a hospital-based health care system was asked to judge whether the outcome in each situation was foreseeable and recognizable, and whether causality was identifiable and controllable. The panel could also suggest additional PDRMs.
Results:
Fifty-two consensus-approved clinical indicators of PDRM in older adults were developed after 2 rounds of the Delphi technique. There was a high degree of consensus among the expert panel: all 7 members agreed on 35 indicators; 6 of 7 members agreed on 15 indicators; and 5 members agreed on 2 indicators. Only 6 outcomes and patterns of care were rejected as indicators.
Conclusions:
This phase of the study showed that consensus on clinical indicators of PDRM can be reached among experts. These indicators could be used by a managed care organization to proactively identify patients at risk for a PDRM and to improve the quality, safety, and appropriateness of medication use. Additionally, the indicators form an important bridge between processes and outcomes of care and could be used in conjunction with HEDIS and other performance indicators.