MTM Quality Metrics & Outcome Assessment 3 — Questions and Answers
Question 1: In the context of CMS Part D Star Ratings, the 'Statin Use in Persons with Cardiovascular Disease' (SUPD) measure is classified as a:
- Process measure (Correct answer)
- Intermediate outcome measure
- Patient experience measure
- Utilization measure
Correct answer: Process measure
SUPD is a process measure because it tracks whether an indicated medication was prescribed and filled, not the health outcome itself.
Question 2: When evaluating MTM program effectiveness, 'number needed to treat' (NNT) is useful because it:
- Quantifies the absolute risk reduction translated into patients treated to prevent one event (Correct answer)
- Identifies which patients have the highest medication burden
- Calculates the cost per quality-adjusted life year
- Determines the statistical power of an outcome study
Correct answer: Quantifies the absolute risk reduction translated into patients treated to prevent one event
NNT = 1/ARR, expressing how many patients must receive an intervention to prevent one additional adverse outcome.
Question 3: A pharmacist reviewing quality data notices that high-risk medication use in the elderly (HRM) rates are elevated. Which of the following drugs would MOST contribute to this measure?
- Lisinopril
- Metformin
- Amitriptyline (Correct answer)
- Atorvastatin
Correct answer: Amitriptyline
Amitriptyline is a tricyclic antidepressant listed on the Beers Criteria as potentially inappropriate in older adults, directly affecting the HRM star measure.
Question 4: A balanced scorecard approach to MTM program evaluation typically includes which four domains?
- Safety, Efficacy, Cost, Patient Experience
- Financial, Customer, Internal Process, Learning & Growth (Correct answer)
- Structure, Process, Outcome, Population Health
- Access, Quality, Efficiency, Equity
Correct answer: Financial, Customer, Internal Process, Learning & Growth
The Kaplan–Norton balanced scorecard framework uses Financial, Customer, Internal Process, and Learning & Growth perspectives to provide a comprehensive organizational view.
Question 5: A MTM pharmacist documents a drug therapy problem (DTP) in a patient on warfarin whose INR is sub-therapeutic at 1.4. The MOST appropriate DTP category is:
- Unnecessary drug therapy
- Needs additional drug therapy
- Dosage too low (Correct answer)
- Adverse drug reaction
Correct answer: Dosage too low
A sub-therapeutic INR on warfarin indicates the dose is insufficient to achieve the desired anticoagulation goal, classifying the DTP as 'dosage too low.'
Question 6: Which statistical method is most appropriate for comparing pre- and post-MTM intervention outcomes in a single patient cohort without a control group?
- Independent samples t-test
- Paired t-test or Wilcoxon signed-rank test (Correct answer)
- Chi-square test of independence
- ANOVA with post-hoc Tukey correction
Correct answer: Paired t-test or Wilcoxon signed-rank test
Paired tests compare the same subjects before and after an intervention, controlling for individual variability without requiring a separate control group.
Question 7: The Medicare Part D 'Improving or Maintaining Physical Health' measure is captured through which data source?
- Pharmacy dispensing records
- EHR clinical notes
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (Correct answer)
- Medicare claims files
Correct answer: Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey
Patient experience and functional health measures in Part D Star Ratings, including physical health status, are collected via the CAHPS survey.
MTM Quality Metrics & Outcome Assessment 3
In the context of CMS Part D Star Ratings, the 'Statin Use in Persons with Cardiovascular Disease' (SUPD) measure is classified as a: