验证基于索赔的定义来减少处方:弥合临床和行政数据之间的差距
Joshua D Niznik1,2,3,4, Shahar Shmuel5, Virginia Pate5
1Division of Geriatric Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA.
Pharmacoepidemiology and drug safety
|April 1, 2024
概括
医院住院后停止处方二类药物 (BZD) 的基于索赔的定义显示,对90天间隔的敏感性低,但特异性高. 对于其他药物,需要进一步的研究.
科学领域:
- 老年医学 老年医学
- 药理学 药理学是指药理学的学科.
- 医疗信息学 医疗信息学
背景情况:
- 有限的研究存在于药物降低处方的基于索赔的定义的准确性.
- 准确识别抑郁症对于评估干预和患者结果至关重要.
研究的目的:
- 评估基于权利要求的定义的有效性,以减少二胺类药物 (BZDs) 的处方.
- 为了将索赔数据定义与电子健康记录 (EHR) 数据进行比较,在与跌倒相关的住院住院后,BZD 减记.
主要方法:
- 连接医疗保险的服务费用 (FFS) 和D部分数据与医疗系统的电子健康记录.
- 确定的患者年龄≥66岁因跌倒而住院,连续注册医疗保险和之前使用BZD.
- 经过验证的基于权利要求的减轻定义 (例如,供应缺口,剂量变化) 与EHR图表对敏感性和特异性的审查相比.
主要成果:
- 在257名患者中,根据索赔数据,BZD减记的患病率从8.2% (没有补充) 到65.8% (包括剂量变化) 不同.
- 在一个验证子样本中 (n=47),大约三分之一的人在EHR中描述了BZD.
- 基于索赔的供应缺口显示了良好的灵敏度但较低的特异性;结合剂量提高了灵敏度但降低了特异性.
结论:
- 基于索赔的BZD解写定义显示了低灵敏度,尽管90天的供应缺口表现出超过90%的特异性.
- 建议在多种EHR系统和其他药物中进行复制,以完善抑郁症的研究方法.
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