Validation of a New Risk Measure for Chronic Obstructive Pulmonary Disease Exacerbation Using Health Insurance Claims Data
| Autor: | Douglas W. Mapel, Todd A. Lee, J F Philip Merrigan, Richard H. Stanford, Arpita Nag, Marjolaine Gauthier-Loiselle, Richard Rosiello, Michael Schatz, Francis Vekeman, Mei Sheng Duh |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Databases Factual Exacerbation Pharmacy Risk Assessment Severity of Illness Index Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Risk Factors Severity of illness Odds Ratio medicine Humans 030212 general & internal medicine Intensive care medicine Aged Retrospective Studies Aged 80 and over COPD business.industry Risk measure Retrospective cohort study Odds ratio Middle Aged medicine.disease United States respiratory tract diseases Hospitalization Logistic Models 030228 respiratory system Disease Progression Physical therapy Female business Risk assessment |
| Zdroj: | Annals of the American Thoracic Society. 13:1067-1075 |
| ISSN: | 2325-6621 2329-6933 |
| DOI: | 10.1513/annalsats.201508-493oc |
| Popis: | Current chronic obstructive pulmonary disease (COPD) exacerbation risk prediction models are based on clinical data not easily accessible to national quality-of-care organizations and payers. Models developed from data sources available to these organizations are needed.This study aimed to validate a risk measure constructed using pharmacy claims in patients with COPD. Administrative claims data were used to construct a risk model to test and validate the ratio of controller (maintenance) medications to total COPD medications (CTR) as an independent risk measure for COPD exacerbations. The ability of the CTR to predict the risk of COPD exacerbations was also assessed.This was a retrospective study using health insurance claims data from the Truven MarketScan database (2006-2011), whereby exacerbation risk factors of patients with COPD were observed over a 12-month period and exacerbations monitored in the following year. Exacerbations were defined as moderate (emergency department or outpatient treatment with oral corticosteroid dispensings within 7 d) or severe (hospital admission) on the basis of diagnosis codes. Models were developed and validated using split-sample data from the MarketScan database and further validated using the Reliant Medical Group database. The performance of prediction models was evaluated using C-statistics.A total of 258,668 patients with COPD from the MarketScan database were included. A CTR of greater than or equal to 0.3 was significantly associated with a reduced risk for any (adjusted odds ratio [OR], 0.91; 95% confidence interval [CI], 0.85-0.97); moderate (OR, 0.93; 95% CI, 0.87-1.00), or severe (OR, 0.87; 95% CI, 0.80-0.95) exacerbation. The CTR, at a ratio of greater than or equal to 0.3, was predictive in various subpopulations, including those without a history of asthma and those with or without a history of moderate/severe exacerbations. The C-statistics ranged from 0.750 to 0.761 for the development set and 0.714 to 0.761 in the validation sets, indicating the CTR performed well in predicting exacerbation risk.The ratio of controller to total medications dispensed for COPD is a measure that can easily be calculated using only pharmacy claims data. A CTR of greater than or equal to 0.3 can potentially be used as a quality-of-care measurement for prevention of exacerbations. |
| Databáze: | OpenAIRE |
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