Prior Authorization QI Project Guide
This guide helps you run a quality improvement (QI) project to measure whether structured PA support improves time to medication access. No PHI is collected.
Suggested Aim Statement
We aim to increase the percentage of patients with [condition] who receive [medication] within 30 days of PA submission from [baseline %] to [target %] over [X months] by using GreenlightPA’s structured documentation and checklist.
Recommended Sample Sizes
- Pilot (Bronze): 10 cases with app + 10 without (feasibility)
- Standard QI (Silver): 20 with + 20 without (solid resident/student project)
- Strong QI (Gold): 30 with + 30 without (poster-ready stability)
Tip: For the cleanest analysis, pick one primary drug + indication + insurer for your main results.
Measures
Primary Outcome
% receiving medication within 30 days of PA submission
Process
Approval rate, days submit→decision, documentation completeness
Access Timing
Days decision→received (captures specialty pharmacy delays)
Workflow
- At PA submission: create a row; record
date_pa_submitted, insurer, drug/indication, and whether the app was used. - When the insurer responds: update
pa_outcomeandpa_outcome_date; add denial category if denied. - When medication is received: update
medication_received,medication_received_date, andreceived_source. - Monthly summary: calculate approval rate and % received within 30 days (simple descriptive analysis; no p-value required).
No PHI Rule
Do not enter names, MRNs, DOBs, phone numbers, addresses, or other identifiers. Use local_patient_key as a private code (e.g., PN-014) that only you can map locally.
Suggested Output for a Poster/Presentation
- Bar chart: approval rate (with vs without app)
- Bar chart: % received within 30 days (with vs without app)
- Table: median days submit→decision and decision→received
- Brief limitations: small sample, selection bias, pharmacy variability