Validating claims-based definitions for deprescribing: Bridging the gap between clinical and administrative data

Area of Science:

• Geriatric Medicine
• Pharmacology
• Health Informatics

Background:

• Limited research exists on the accuracy of claims-based definitions for medication deprescribing.
• Accurate identification of deprescribing is crucial for evaluating interventions and patient outcomes.

Purpose of the Study:

• To assess the validity of claims-based definitions for deprescribing benzodiazepines (BZDs).
• To compare claims data definitions against electronic health record (EHR) data for BZD deprescribing following a fall-related hospitalization.

Main Methods:

• Linked Medicare fee-for-service (FFS) and Part D data with health system EHRs.
• Identified patients aged ≥66 years hospitalized for falls, with continuous Medicare enrollment and prior BZD use.
• Validated claims-based deprescribing definitions (e.g., supply gaps, dosage changes) against EHR chart reviews for sensitivity and specificity.

Main Results:

• Among 257 patients, BZD deprescribing prevalence varied from 8.2% (no refills) to 65.8% (including dosage changes) based on claims data.
• In a validation sub-sample (n=47), about one-third had BZDs deprescribed in the EHR.
• Claims-based supply gaps showed good sensitivity but poor specificity; incorporating dosage improved sensitivity but decreased specificity.

Conclusions:

• Claims-based definitions for BZD deprescribing demonstrated low sensitivity, though a 90-day supply gap exhibited over 90% specificity.
• Replication in diverse EHR systems and for other medications is recommended to refine deprescribing research methodologies.