Center for Pharmacy Innovation and Outcomes
Medications are often the primary therapeutic option for patients. Despite advances in treatments and growing evidence supporting best use, gaps in care related to medication use remain, resulting in substantial patient burden (cost, morbidity and mortality) and economic waste in an already stretched healthcare ecosystem.
Within the modern healthcare environment, real-world evaluation studies provide evidence of effectiveness of therapy and gaps in care, new and evolving models of healthcare delivery offer hope of improved outcomes, and implementation of optimal and nimble models of care afford insight into improving medication use.
The Center for Pharmacy Innovation and Outcomes (CPIO) was established in 2015 in partnership with Geisinger’s Enterprise Pharmacy, which oversees system-wide medication use platforms in acute, ambulatory, community and managed care settings, and Geisinger’s Research enterprise to investigate gaps in medication use within the real-world setting and deploy, evaluate and generalize team-based approaches to care.
Specifically, the CPIO uses:
- Quantitative and qualitative designs - interrogating data and gathering relevant information on patients, providers and payors
- Health services research - evaluating effectiveness of embedded and trained pharmacists within a team-based setting
- Informatics - leveraging a highly evolved health information technology infrastructure
- Pharmacogenomics - integrating a growing genomic reservoir of information
- Implementation science - scaling and sustaining high-fidelity effective medication use approaches
- Michael Evans, BS, RPh, Pharmacy leadership
- Eric Wright, PharmD, MPH, CPIO leadership
- Benjamin Andrick, PharmD, BCOP
- Jove Graham, PhD
- Adam Gross, PharmD, CCRP
- Karina Phang, MD
- Ryley Uber, PharmD
Pharmacy initiatives and projects
Machine Learning Approach to Venous Thromboembolism Prediction in Newly Diagnosed Patients with Cancer Receiving Chemotherapy
Venous Thromboembolism (VTE) is a major source of morbidity and mortality in cancer patients. Currently, the Khorana score is standard clinical predictive model to stratify cancer patients’ risk for VTE. However, evidence has shown limited predictability of Khorana score to predict VTE. Thus, there is unmet clinical predictive need for this high-risk cancer patient population. This is a retrospective study to test new machine learning models against established clinical tools like the Khorana score to predict which cancer patients with chemotherapy may develop venous thromboembolism.
Implementation and Evaluation of Preemptive Pharmacogenomics Testing in an Aging Population
It is estimated that >90% of patients above the age of 65 years will presently or within a 5-year period be prescribed a medication influenced by variable genomic expression in patients, which is not predictable without preemptive pharmacogenomic testing. Despite evidence, preemptive pharmacogenomic testing is not standard practice, often confined to select medications in defined populations (e.g. testing for CYP 2C19 genomic variations in PCI patients) and regularly limited to only single gene testing despite similar costs of pharmacogenomic panel tests. The primary goal of this study is to conduct pharmacogenomics testing (a type of DNA test) within an aging population and measure the impact of this test on medication selection, dosing, healthcare utilization, and costs of care. https://clinicaltrials.gov/ct2/show/NCT05091879
Hematopoietic cellular transplant medication therapy disease management program
Hematopoetic cellular transplant (HCT) is a commonly utilized treatment modality for the treatment of patients with specific hematological malignancies. To date, most transplants at Geisinger have been the infusion, not transplantation, of the donor’s own hemotopoetic stem cells. However, by transplantation of donor stem cells, an immunological response can be induced resulting in a durable remission and potentially, a cure.
This project seeks to implement a HCT medication therapy disease management program at Geisinger to improve clinical and quality outcomes for the medically complex stem cell transplant population. This pilot will provide, and justify, the best clinical pharmacy services for the HCT patients at Geisinger since there is no established longitudinal pharmacy service today.
Implementation and evaluation of clinic-based medication disposal procedures to reduce unwanted and unused controlled substances in homes
Contemporary evidence suggests that without education or assistance, the majority of patients retain opioid prescriptions for long periods of time following prescription, storing medications within accessible locations, often leading to misuse and diversion.
Evidence from recent trials suggest patients more often properly dispose of unused opioids if instructed by a healthcare professional, if provided education on proper storage and disposal, and provided a physical medication disposal system (e.g. mail back bags). It is not clear how this evidence applies to patients in primary care and if the effectiveness is comparable to that seen in other more controlled studies, largely limited to the post-surgical population.
Our objective is to evaluate the effectiveness and implementation of a program designed to improve safe medication disposal among patients newly prescribed opioid medications within a primary care setting.
Clinical and economic impact of osteoarthritis
Osteoarthritis is a common condition with high morbidity and costs of care. Treatment varies based upon the severity of the illness. Describing the course of care for patients with osteoarthritis provides insight into treatment strategies in the real world while identifying opportunities to improve care and outcomes such as utilization and costs.
The objective of this study is to outline the treatment course and patterns of utilization and costs for patients with osteoarthritis and associate variables such as disease severity with patterns of use.
Implementation and evaluation of comprehensive medication management within the Geisinger at Home population
To control rising healthcare costs and improve quality, healthcare systems have designed approaches to care for patients within the home who have high levels of healthcare utilization.
Pharmacists, as part of a multidisciplinary team within these programs, provide a variety of services including comprehensive medication management, a collaborative patient-centered approach to medication optimization.
This study will evaluate the implementation and outcomes related to comprehensive medication management in the Geisinger at Home population.
Improving medication reconciliation processes through observation and evaluation
Medication reconciliation is the process of comparing two or more medication lists and fixing any discrepancies to ensure patients and providers have an accurate account of medications.
Numerous studies have been conducted to understand the process and outcomes of medication reconciliation, but unfortunately, up to 80 percent of medication lists are inaccurate, which can lead to adverse drug events and serious harm.
This study will review the literature and collect data using onsite observations, interviews and surveys to better understand the current state of medication reconciliation at Geisinger. Working with Geisinger’s ambulatory pharmacy team, the study’s findings will be used to inform and roll out standardized medication review education for all ambulatory staff which will be used as a baseline to formally evaluate the impact of the education on medication list review.