The quality of quality measures: HEDIS® quality measures for medication management in the elderly and outcomes associated with new exposure.
The quality of quality measures: HEDIS® quality measures for medication management in the elderly and outcomes associated with new exposure.
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DOI：
10.1007/s40266-013-0086-8
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发表时间：
2013-08
期刊：
影响因子：
2.8
通讯作者：
Hanlon JT
中科院分区：
文献类型：
--
作者：
Pugh MJ;Marcum ZA;Copeland LA;Mortensen EM;Zeber JE;Noël PH;Berlowitz DR;Downs JR;Good CB;Alvarez C;Amuan ME;Hanlon JT
医疗保健效果数据和信息集（HEDIS®）措施的老年人不适当处方的临床验证研究有限。本研究的目的是检查老年人新接触高危药物（HRME）和药物-疾病相互作用（Rx-DIS）与死亡率、住院和急诊护理的关系。进行了一项回顾性数据库研究，检查2006财政年度（2005年10月至2006年9月; 2006财政年度）HRME和Rx-DIS的新使用，索引日期为首次HRME/Rx-DIS暴露的日期，如果没有HRME/Rx-DIS暴露，则为2007财政年度的第一天。在索引日期后一年评估结局。参与者是在2006财年≥65岁并在2005 - 2006财年接受退伍军人健康管理局（VA）护理的退伍军人。根据Rx-DIS子样本定义的诊断代码，有福尔斯/髋部骨折、慢性肾衰竭和/或痴呆病史。这些变量包括2006财年新的独特HRME药物暴露和新的独特Rx-DIS药物暴露（0，1，>1）的数量，以及结局（即，1-年死亡率、住院和急诊）。描述性统计量总结了总体HRME队列和Rx-DIS子集的变量。使用具有logit链接的广义估计方程（GEE）模型的多变量统计分析解释了机构内患者的嵌套。对于后一种分析，我们控制了人口统计学特征、慢性病状态和前一年的疾病负担指标（例如，处方、急诊/医院护理数量）。在符合纳入标准的1，807，404名退伍军人中，5.2%有新的HRME暴露。在Rx-DIS队列的256，388人中，3.6%有新的Rx-DIS暴露。多变量分析发现HRME与死亡率显著相关（1：调整后比值比[AOR]=1.62，95% CI 1.56-1.68; >1：AOR=1.80; 95% CI 1.45-2.23），住院（1：AOR=2.31，95% CI 2.22-2.40; >1：AOR=3.44，95% CI 3.06-3.87）和急诊护理（1：AOR=2.59，95% CI 2.49-2.70; >1：AOR=4.18，95% CI 3.71-4.71）。Rx-DIS暴露与死亡率显著相关（1：AOR=1.60，95% CI 1.51-1.71; >1：AOR=2.00; 95% CI 1.38-2.91），因一次暴露而住院（1：AOR=1.12; 95% CI 1.03-1.27; >1：AOR=1.18; 95% CI 0.71-1.95）和两次或多次暴露的紧急护理（1：AOR=1.06; 95% CI 0.97-1.15; >1：AOR=2.0; 95% CI 1.35-3.10）。分析支持HRME/Rx-DIS暴露与老年退伍军人临床显著结局之间的联系。现在是时候开始将接受这些药物的患者和处方制定方法以减少这些药物暴露的提供者的意见结合起来了。
Clinical validation studies of the Healthcare Effectiveness Data and Information Set (HEDIS®) measures of inappropriate prescribing in the elderly are limited. The objective of this study was to examine associations of new exposure to High Risk Medication in Elderly (HRME) and drug-disease interaction (Rx-DIS) with mortality, hospital admission, and emergency care. A retrospective database study was conducted examining new use of HRME and Rx-DIS in fiscal year 2006 (Oct 2005-Sep 2006; FY06), with index date being date of first HRME/Rx-DIS exposure, or first day of FY07 if no HRME/Rx-DIS exposure. Outcomes were assessed one year after index date. The participants are veterans who were ≥65 years old in FY06and received Veterans Health Administration (VA) care in FY05-06. A history of falls/hip fracture, chronic renal failure, and/or dementia per diagnosis codes defined the Rx-DIS subsample. The variables included a number of new unique HRME drug exposures and new unique Rx-DIS drug exposure (0, 1, >1) in FY06, and outcomes (i.e., 1-year mortality, hospital admission, and emergency care) up to one year after exposure. Descriptive statistics summarized variables for the overall HRME cohort and the Rx-DIS subset. Multivariable statistical analyses using Generalized Estimating Equations (GEE) models with a logit link accounted for nesting of patients within facilities. For these latter analyses, we controlled for demographic characteristics, chronic disease states, and indicators of disease burden the previous year (e.g., number of prescriptions, emergency/hospital care). Among the 1,807,404 veterans who met inclusion criteria, 5.2% had new HRME exposure. Of the 256,388 in the Rx-DIS cohort, 3.6% had new Rx-DIS exposure. Multivariable analyses found that HRME was significantly associated with mortality (1: adjusted odds ratio [AOR]=1.62, 95% CI 1.56-1.68; >1: AOR=1.80; 95% CI 1.45-2.23), hospital admission (1: AOR=2.31, 95% CI 2.22-2.40; >1: AOR=3.44, 95% CI 3.06-3.87) and emergency care (1: AOR=2.59, 95% CI 2.49-2.70; >1: AOR=4.18, 95% CI 3.71-4.71). Rx-DIS exposure was significantly associated with mortality (1: AOR=1.60, 95% CI 1.51-1.71; >1: AOR=2.00; 95% CI 1.38-2.91), hospital admission for one exposure (1: AOR=1.12, 95% CI 1.03-1.27; >1: AOR=1.18; 95% CI 0.71-1.95) and emergency care for two or more exposures (1: AOR=1.06; 95% CI 0.97-1.15; >1: AOR=2.0; 95% CI 1.35-3.10. Analyses support the link between HRME/Rx-DIS exposure and clinically significant outcomes in older Veterans. Now is the time to begin incorporating input from both patients who receive these medications and providers who prescribe to develop approaches to reduce exposure to these agents.
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DOI：
10.1111/j.1532-5415.2009.02269.x
发表时间：
2009-06-01
影响因子：
6.3
作者：
Chrischilles, Elizabeth A.;VanGilder, Rachel;Wallace, Robert B.
通讯作者：
Wallace, Robert B.
影响因子：
2.8
作者：
Albert, Steven M.;Colombi, Alberto;Hanlon, Joseph
通讯作者：
Hanlon, Joseph
影响因子：
2.9
作者：
Lund, Brian C.;Steinman, Michael A.;Kaboli, Peter J.
通讯作者：
Kaboli, Peter J.
影响因子：
158.5
作者：
Budnitz, Daniel S.;Lovegrove, Maribeth C.;Richards, Chesley L.
通讯作者：
Richards, Chesley L.
影响因子：
--
作者：
Fick, DM;Cooper, JW;Beers, MH
通讯作者：
Beers, MH