A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data

Autor: Mary E. Tinetti, Angela Larkin, William C. Cushman, Dawn Bravata, Lillian Min, Hyungjin Myra Kim, Eve A. Kerr, Jinkyung Ha, Timothy P. Hofer, Jeremy B. Sussman, Carole E. Aubert, Matthew L. Maciejewski, Kenneth M. Langa, Chiao-Li Chan, Leah Gillon
Rok vydání: 2021
Předmět:
Zdroj: JAMA Network Open
Min, Lillian; Ha, Jin-Kyung; Aubert, Carole E; Hofer, Timothy P; Sussman, Jeremy B; Langa, Kenneth M; Tinetti, Mary; Kim, Hyungjin Myra; Maciejewski, Matthew L; Gillon, Leah; Larkin, Angela; Chan, Chiao-Li; Kerr, Eve A; Bravata, Dawn; Cushman, William C (2021). A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data. JAMA Network Open, 4(1), e2034059. American Medical Association 10.1001/jamanetworkopen.2020.34059
ISSN: 2574-3805
Popis: Key Points Question Can the intensity of hypertension treatment by total dose burden for older patients be accurately quantified using only health system administrative pharmacy fill data? Findings In this cross-sectional study, dose intensity measured using pharmacy data in a national health care system was highly correlated with dose intensity documented in clinical notes by using a new algorithm that can be applied to an individual patient on any given day. Meaning This study suggests that intensity of hypertension treatment can be measured using pharmacy data at a more detailed level than using medication counts or blood pressure alone for quality comparison or as a research tool.
Importance Simple measures of hypertension treatment, such as achievement of blood pressure (BP) targets, ignore the intensity of treatment once the BP target is met. High-intensity treatment involves increased treatment burden and can be associated with potential adverse effects in older adults. A method was previously developed to identify older patients receiving intense hypertension treatment by low BP and number of BP medications using national Veterans Health Administration and Medicare Part D administrative pharmacy data to evaluate which BP medications a patient is likely taking on any given day. Objective To further develop and validate a method to more precisely quantify dose intensity of hypertension treatment using only health system administrative pharmacy fill data. Design, Setting, and Participants Observational, cross-sectional study of 319 randomly selected older veterans in the national Veterans Health Administration health care system who were taking multiple BP-lowering medications and had a total of 3625 ambulatory care visits from July 1, 2011, to June 30, 2013. Measure development and medical record review occurred January 1, 2017, through November 30, 2018, and data analysis was conducted from December 1, 2019, to August 31, 2020. Main Outcomes and Measures For each BP-lowering medication, a moderate hypertension daily dose (HDD) was defined as half the maximum dose above which no further clinical benefit has been demonstrated by that medication in hypertension trials. Patients’ total HDD was calculated using pharmacy data (pharmacy HDDs), accounting for substantial delays in refills (>30 days) when a patient’s pill supply was stretched (eg, cutting existing pills in half). As an external comparison, the pharmacy HDDs were correlated with doses manually extracted from clinicians’ visit notes (clinically noted HDDs). How well the pharmacy HDDs correlated with clinically noted HDDs was calculated (using C statistics). To facilitate interpretation, HDDs were described in association with the number of medications. Results A total of 316 patients (99.1%) were male; the mean (SD) age was 75.6 (7.2) years. Pharmacy HDDs were highly correlated (r = 0.92) with clinically noted HDDs, with a mean (SD) of 2.7 (1.8) for pharmacy HDDs and 2.8 (1.8) for clinically noted HDDs. Pharmacy HDDs correlated with high-intensity, clinically noted HDDs ranging from a C statistic of 92.8% (95% CI, 92.0%-93.7%) for 2 or more clinically noted HDDs to 88.1% (95% CI, 85.5%-90.6%) for 6 or more clinically noted HDDs. Conclusions and Relevance This study suggests that health system pharmacy data may be used to accurately quantify hypertension regimen dose intensity. Together with clinic-measured BP, this tool can be used in future health system–based research or quality improvement efforts to fine-tune, manage, and optimize hypertension treatment in older adults.
This cross-sectional study develops and validates a method to more precisely quantify dose intensity of hypertension treatment using only health system administrative pharmacy fill data.
Databáze: OpenAIRE
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