Development of Clinical Pharmacy Key Performance Indicators for Ambulatory Oncology Using a Modified Delphi Approach

Abstract

Introduction: Ambulatory Oncology Clinical Pharmacy Key Performance Indicators (AOcpKPIs) are quantitative measures that reflect the quality of care provided by pharmacists to ambulatory oncology patients. In this research project, AOcpKPIs were selected to advance pharmacy practice to improve patient outcomes. Research completed prior to this work involved a cross-sectional survey as part of a Canadian environmental scan. This survey revealed that 98% of respondents supported the development of AOcpKPIs for ambulatory oncology pharmacy practice. The primary objective of this project was to identify targeted processes of care aimed at improving ambulatory oncology patient outcomes represented by critical activity topics (pharmacist interventions), which were used to develop quantifiable AOcpKPIs.

Methods: A literature review on evidence-informed critical activity topics revealed that certain care processes delivered by ambulatory oncology pharmacists had a positive impact on patient outcomes. A steering group comprised of expert ambulatory oncology pharmacists created evidence summary tables by critically appraising and assessing articles to identify “Ambulatory Oncology Critical Activity Topics”. A list of 15 candidate AOcpKPIs was generated by the steering group to serve as metrics to represent 9 evidence-linked critical activity topics. A sample of 18 pharmacists was purposively selected by the steering group to participate in a Delphi panel with the goal of reaching consensus on AOcpKPIs to adopt. This research project employed a modified Delphi process (a structured method to reach consensus among experts through multiple rounds of surveys and discussion in a meeting) where panelists ranked the a priori selected candidate AOcpKPIs on a 9-point Likert scale in the initial round and then reviewed the rankings and comments of the first round to re-rank the 15 AOcpPKIs in round 2. A final consensus was reached in the third round following a live meeting discussing marginal candidate AOcpPKIs from the second round.

Results: After the first round of the Delphi process, 9 candidate AOcpKPIs reached preliminary consensus. This number increased to 12 after the second round. During a live meeting, discussions about the wording and meaning of the candidate AOcpKPIs led to the addition of 2 new candidates, totaling to 17 for the third round. Following the third round, 14 AOcpKPIs achieved consensus. These cpKPIs highlight essential pharmacist contributions, such as reviewing clinical orders, providing patient education on medications, assessing medication adherence, pharmaceutical care plan (oncology), pharmaceutical care plan (non-oncology), follow-up, bundled patient care interventions, medication history assessment and addressing drug therapy issues.

Significance: This research project identified 14 quantifiable AOcpKPIs, based on ambulatory oncology patient outcomes, that represent critical activity topics. Through a systematic, evidence-informed consensus-building process, the final suit of consensus AOcpKPIs that improve patient outcomes were formed. Future efforts will focus on implementing these metrics in ambulatory oncology pharmacy practice to measure and ensure the quality of patient care.