Quality and outcome: pharmacy's professional imperative

Societal forces behind the increased use of outcomes to measure the quality of health care are described, and continuous improvement of outcomes as a goal for pharmacy is discussed. Consumerism, the demands of the aging American population, and problems of access to care for many Americans have helped to bring about an examination of quality. The effectiveness of clinical decision-making methods has been challenged. The Joint Commission on Accreditation of Healthcare Organizations now seeks to examine whether quality care is being provided, rather than whether the capacity exists to provide it. Inspection against criteria to determine quality will be superseded by a goal of continuous improvement. Traditional drug-use evaluation needs to go beyond collection of data and confrontation of noncompliant prescribing. Multidisciplinary quality improvement efforts should focus on patient outcomes; the goal should be to prevent all errors, rather than to not exceed some tolerable rate of errors. Pharmacists and risk managers should share information. Documentation of quality assurance efforts will be required. Drug-use evaluations should include assessment for therapeutic failure. Pharmacy quality improvement efforts can improve patient care and expand the pharmacist's role on the health-care team.