Outcomes evaluation: striving for excellence in ambulatory care pharmacy practice.

PURPOSE Key issues in measuring and improving the quality of healthcare are discussed with an emphasis on applying quality-improvement principles in ambulatory care pharmacy practice. SUMMARY The various perspectives on healthcare quality (including those of patients, providers, and payers) are reviewed, and the basic principles of quality measurement and improvement are outlined. Many healthcare practitioners believe that the most effective way to improve healthcare is through balanced consideration of the structure, process, and outcomes of healthcare services. Overall progress in improving the quality of healthcare has been slow, in part because of lack of patient engagement, use of improvement methods that have not been fully tested, and inadequate attention to the systems of providing care. Ongoing efforts of national quality-improvement organizations are reviewed, including those of the government, accreditation bodies, payers, and professional associations. Of special interest in pharmacy is the work of the Pharmacy Quality Alliance, the Patient Safety and Clinical Pharmacy Services Collaborative, and the Center for Pharmacy Practice Accreditation. Ambulatory care pharmacists have important opportunities to improve healthcare quality, including by reducing adverse drug events, improving medication reconciliation and transitions of care, fostering medication adherence, improving patient medication self-management, providing immunization services, and reducing disparities in access to medications. CONCLUSION To be fully effective, the national priority of improving the quality of healthcare must penetrate the work of individual healthcare practitioners, including ambulatory care pharmacists.