Implementation and evaluation of a standardized CMM practice management assessment tool in the Veterans Health Administration

Comprehensive medication management (CMM) is defined as the standard of care that ensures each patient's medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given any comorbidities and other medications being taken, and able to be taken by the patient as intended. The practice management component of CMM can be defined as "the structural and system level supports within a practice related to practice management and operations that enable the efficiency, effectiveness, and sustainability of CMM services." To date, there has been no consistent process in the Veterans Health Administration (VHA) to evaluate CMM practice management standardization. This article will describe the VHA effort in development, implementation, and outcomes of a CMM practice optimization tool modified from an existing tool. A modified version of practice management assessment tool was developed to integrate and align with VHA clinical pharmacy practice and policy. The VHA CMM Practice Optimization and Evaluation Tool (POET) was developed to access CMM practice management in multiple practice areas and was deployed for assessment in all VHA facilities. From May 2021 to March 2022, 352 practice area evaluations were completed at 152 VHA facilities using POET. Total submission practice area detail was gathered from 245 Patient Aligned Care Team (primary care), 32 outpatient mental health, 29 acute care, 11 pain, 11 specialty ambulatory care, 8 geriatric community living centers (eg, long-term care) or hospice, 6 home-based primary care, 4 critical care, 4 emergency department, and 2 residential rehabilitation and treatment programs. This work evaluating the five essential core practice management domains of CMM using a standardized evaluation process revealed that the VHA could adapt a tool that yields immeasurable information for standardization of CMM provided by a clinical pharmacist.