Key Performance Indicators and Metrics for the Implementation of an Oral Chemotherapy Adherence Program

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Benyam Muluneh UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC

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James B. Collins IV UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
GSK, Durham, NC

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Brian Lam UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC

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Emily Mackler Michigan Medicine, Ann Arbor, MI

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Jennifer Elston Lafata UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC

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Background: Oral anticancer agents (OAAs) transformed cancer care for patients, extending survival and delaying progression in certain cases. There are multiple pharmacy-driven models to improve patient knowledge and adherence to OAAs. However, a lack of measurable key performance indicators (KPIs) has limited the adoption, implementation, and maintenance of these models. The objective of this study was to identify a set of KPIs, their metrics, and the target values that indicated improved patient care through an OAA adherence program. Methods: A literature review was conducted to identify an initial list of defined KPIs, metrics of the KPIs, and targets for success. We assembled an advisory panel of clinicians (n=9), administrators (n=7), and patients (n=2) from across an academic and affiliated community cancer center to gauge agreement on identified KPIs for use within a structured adherence intervention. We used a Qualtrics survey consisting of questions measured using a 5-point Likert scale response that ranged from 1 (strongly disagree) to 5 (strongly agree) and a subsequent consensus-building discussion with the advisory panel to identify agreeability with the definitions, metrics, and targets of identified KPIs. Results: Eleven KPIs were identified: (1) time to intended OAA initiation; (2) adherence rate during active treatment; (3) adverse events; (4) medication-related financial toxicity; (5) patient satisfaction; (6) treatment-related emergency department visits; (7) treatment-related hospital admissions; (8) proportion of patients with adherence, toxicity, and financial barriers assessed; (9) proportion of patients referred to social work; (10) time spent by patient in each phase of care as defined by the intervention’s standard operating procedure; and (11) revenue generated by billing for service. Conclusions: This study identified 11 KPIs that can be used in evaluating the success of an OAA adherence program. Use of these KPIs will be piloted after formal implementation of the program in both academic and community cancer centers.

Submitted June 28, 2023; final revision received October 23, 2023; accepted for publication October 27, 2023. Published online March 19, 2024.

Author contributions: Study design: Muluneh, Collins, Mackler, Elston Lafata. Data acquisition: Muluneh, Collins, Lam. Data analysis: Muluneh, Collins. Writing—original draft: Muluneh, Collins. Writing—review & editing: Lam, Mackler, Elston Lafata.

Disclosures: Dr. Muluneh has disclosed serving as a consultant for Servier Pharmaceuticals; and having a spouse who owns stock or has an ownership interest in Novartis Pharmaceuticals. Dr. Collins has disclosed being employed by GSK. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR002490 (B. Muluneh).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Correspondence: Benyam Muluneh, PharmD, BCOP, CPP, UNC Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Lane, CB#7569, Chapel Hill, NC 27599. Email: bmuluneh@unc.edu
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  • Expand
  • 1.

    Druker BJ, Guilhot F, O’Brien SG, et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 2006;355:24082417.

  • 2.

    Bedell CH. A changing paradigm for cancer treatment: the advent of new oral chemotherapy agents. Clin J Oncol Nurs 2003;7:59.

  • 3.

    Kong JH, Go TH, Lee JY, et al. Adherence to tyrosine kinase inhibitor affects overall survival in adult Korean chronic myeloid leukemia patients; based on the National Health Information Database. Blood 2018;132(Suppl 1):1745.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Collins J 4th, Stump SE, Heiling H, et al. Impact of adherence to ibrutinib on clinical outcomes in real-world patients with chronic lymphocytic leukemia. Leuk Lymphoma 2022;63:18231830.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Marin D, Bazeos A, Mahon FX, et al. Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol 2010;28:23812388.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Partridge A, Kato P, DeMichele A Adherence to oral cancer therapies: challenges and opportunities. Am Soc Clin Oncol Educ Book, 2009;124128.

  • 7.

    Muluneh B, Schneider M, Faso A, et al. Improved adherence rates and clinical outcomes of an integrated, closed-loop, pharmacist-led oral chemotherapy management program. J Oncol Pract 2018;14:e324334.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Zerillo JA, Goldenberg BA, Kotecha RR, et al. Interventions to improve oral chemotherapy safety and quality: a systematic review. JAMA Oncol 2018;4:105117.

  • 9.

    Rosenberg SM, Petrie KJ, Stanton AL, et al. Interventions to enhance adherence to oral antineoplastic agents: a scoping review. J Natl Cancer Inst 2020;112:443465.

  • 10.

    Pritchard RD, Harrell MM, DiazGranados D, et al. The productivity measurement and enhancement system: a meta-analysis. J Appl Psychol 2008;93:540567.

  • 11.

    Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med 2000;51:16111625.

  • 12.

    Doucette D, Millin B. Should key performance indicators for clinical services be mandatory? Can J Hosp Pharm 2011;64:5557.

  • 13.

    Gu X, Itoh K. Performance indicators: healthcare professionals’ views. Int J Health Care Qual Assur 2016;29:801815.

  • 14.

    Muluneh B, Muir MA, Collins JB, et al. Barriers and facilitators associated with implementing interventions to support oral anticancer agent adherence in academic and community cancer center settings. PLoS One 2023;18:e0286630.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Hill M, Gluyas H, Sandy M, et al. Healthcare managers’ perceptions of managing poor performance. J Health Organ Manag 2018;32:416427.

  • 16.

    Ilgen DR, Moore CF. Types and choices of performance feedback. J Appl Psychol 1987;72:401406.

  • 17.

    Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 2012;73:691705.

  • 18.

    Sattler EL, Lee JS, Perri M 3rd Medication (re)fill adherence measures derived from pharmacy claims data in older Americans: a review of the literature. Drugs Aging 2013;30:383399.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Wilson IB, Lee Y, Michaud J, et al. Validation of a new three-item self-report measure for medication adherence. AIDS Behav 2016;20:27002708.

  • 20.

    Geynisman DM, Wickersham KE. Adherence to targeted oral anticancer medications. Discov Med 2013;15:231241.

  • 21.

    Marshall GN, Hays RD. The patient satisfaction questionnaire short-form (PSQ-18). Accessed December 15, 2023. Available at: https://www.rand.org/content/dam/rand/pubs/papers/2006/P7865.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:17431748.

  • 23.

    Loerzel VW, Hines RB, Deatrick CW, et al. Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting. Support Care Cancer 2021;29:75257533.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Carlotto A, Hogsett VL, Maiorini EM, et al. The economic burden of toxicities associated with cancer treatment: review of the literature and analysis of nausea and vomiting, diarrhoea, oral mucositis and fatigue. Pharmacoeconomics 2013;31:753766.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Mackler E, Segal EM, Muluneh B, et al. 2018 Hematology/Oncology Pharmacist Association Best Practices for the Management of Oral Oncolytic Therapy: pharmacy practice standard. J Oncol Pract 2019;15:e346355.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Dillmon MS, Kennedy EB, Anderson MK, et al. Patient-centered standards for medically integrated dispensing: ASCO/NCODA standards. J Clin Oncol 2020;38:633644.

  • 27.

    Neuss MN, Polovich M, McNiff K, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum 2013;40:225233.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Mislang AR, Wildes TM, Kanesvaran R, et al. Adherence to oral cancer therapy in older adults: the International Society of Geriatric Oncology (SIOG) taskforce recommendations. Cancer Treat Rev 2017;57:5866.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Belcher SM, Mackler E, Muluneh B, et al. ONS guidelines to support patient adherence to oral anticancer medications. Oncol Nurs Forum 2022;49:279295.

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