University of Iowa Hospital and Clinics: outcomes management.

Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.

The integration of quality assessment and a patient-specific intervention/outcomes program.

The clinical intervention program in place at the University of Iowa Hospitals and Clinics is based on the pharmacist's evaluation of the patient, the disease state, and the appropriateness of the selected therapy. The system was developed so that all pharmacists within our institution: staff pharmacists, clinical pharmacy specialists, clinical pharmacists, and pharmacy residents can easily and efficiently document all interactions with other health care providers. The recent introduction of the Medication Use Indicators process by the Joint Commission has provided many pharmacy departments with a series of outcome measurements which may prove useful in their attempts to maximize contributions to the medication use process. In this article, we describe how our department has begun to utilize the Joint Commission indicator data by integrating information from them into the daily practices of our staff, and how our department has utilized a formal interventions and outcomes program to evaluate such efforts.

Locally derived clinical practice guidelines using a decision analysis model.

As health-care providers continually are faced with the need to identify the most cost-effective modalities when initiating therapy among many therapeutic options, standardized clinical guidelines become the foundation for decision making. This article discusses how decision analysis can be useful in the formulation of locally derived clinical practice guidelines. The following is an example of using decision analysis to evaluate data gathered within the institution, supplemented by peer-reviewed literature, to choose the most cost-effective agent in the treatment of chemotherapy-induced nausea and vomiting at the authors' institution.

Increased adverse drug reaction reporting through wall-mounted ADR reporting cards.

To increase adverse drug reaction reporting, the Pharmacy Department Quality Assessment and Improvement Committee at the University of Iowa Hospitals and Clinics created an abbreviated wall-mounted adverse drug reaction card on "tear-off" pads. This report discusses strategies the Committee identified in order to attain its goal.

Application of decision analysis in antibiotic formulary choices.

OBJECTIVE: To introduce the reader to the fundamentals involved in using decision analysis as a tool in evaluating the associated costs and effectiveness of comparable therapeutic agents. DATA SOURCES: Currently available literature citations were used to provide the reader with basic references whose purpose is to provide a step-by-step approach for using Decision Analysis in conducting a cost-effective comparison of three commonly used antibiotics. Data were gathered from a previously conducted retrospective chart review where the three antibiotics were used for either prophylactic, empiric, or documented infections. Although this study was limited by its retrospective nature, the reader can use the data to appreciate the fundamentals of decision analysis. CONCLUSIONS: The continually changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease has increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective. Decision analysis can be used to compare therapeutic agents, in terms of financial as well as clinical outcomes, in a structured fashion that all members of the health care team can understand. The application of Decision analysis is appropriate for many therapeutic agents, not just antibiotics.

Dopamine versus dobutamine: are all the facts there?

During the last 5 years we believe that the prescribing of dobutamine has increased over that of the older agent dopamine. The literature reports advantages such as less tachycardia, less peripheral vasoconstriction, and fewer increases in intracardiac pressures with dobutamine as opposed to dopamine. After a thorough review of the literature, we were unable to find conclusive evidence of these initial findings, and present several studies to show potential flaws in their interpretation that may help explain the increased use of dobutamine over dopamine. The overuse of dobutamine, if it does exist, must be dealt with by pharmacy departments in an informed, yet unbiased fashion, to aid in preventing the continued escalation of health care costs.