The development and evaluation of a predictive productivity model in the ambulatory oncology infusion setting.

PURPOSE: Accurately describing pharmacy productivity in the ambulatory oncology infusion setting is important to ensure appropriate labor utilization. The purpose of this study was to develop a productivity model utilizing weighted medication complexity and prospective schedule data to determine if predicted productivity corresponds to actual productivity across 6 ambulatory oncology infusion sites. METHODS: This study was a 2-part analysis. Part 1 was to modify the historic productivity model from dispense code weighting to individual medication complexity weighting. Medication-specific relative value units were determined by analyzing 12 months of historic timestamp data from the electronic health record and gravimetric technology software. The productivity model containing updated relative value units was compared to the historic model to determine if the difference in total calculated full-time equivalents (FTEs) was within 2.0 FTEs. Part 2 applied prospective infusion schedule data to the updated model to determine if predicted productivity corresponded to actual productivity (within 2.0 FTEs) for pharmacy infusion services. RESULTS: The mean difference in total calculated FTEs for infusion during the study period was 2.46 (standard deviation = 1.87) and was within the range of 2.0 FTEs (P = 0.54), indicating that the updated model was not statistically different from the historic model. The mean difference in total calculated FTEs between the predictive and actual productivity model for infusion was 18.28 (standard deviation = 1.00) and was out of the range of 2.0 FTEs (P < 0.001), indicating that predicted productivity was statistically different from the actual productivity. CONCLUSION: Medication complexity weighting can be used to provide a comprehensive assessment of workload and productivity across pharmacy infusion services. The methodology used to assess predictive productivity should be explored further.

Costs associated with United States pharmacopeia compliant infusion clinics.

PURPOSE: As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. METHODS: Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia <797> and <800> pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. RESULTS: Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207-$1,535,207 and $965,207-$1,005,207, respectively. CONCLUSIONS: Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.