Validating claims-based definitions for deprescribing : Bridging the gap between clinical and administrative data
© 2024 John Wiley & Sons Ltd..
BACKGROUND: Limited research has evaluated the validity of claims-based definitions for deprescribing.
OBJECTIVES: Evaluate the validity of claims-based definitions of deprescribing against electronic health records (EHRs) for deprescribing of benzodiazepines (BZDs) after a fall-related hospitalization.
METHODS: We used a novel data linkage between Medicare fee-for-service (FFS) and Part D with our health system's EHR. We identified patients aged ≥66 years with a fall-related hospitalization, continuous enrollment in Medicare FFS and Part D for 6 months pre- and post-hospitalization, and ≥2 BZD fills in the 6 months pre-hospitalization. Using a standardized EHR abstraction tool, we adjudicated deprescribing for a sub-sample with a fall-related hospitalization at UNC. We evaluated the validity of claims-based deprescribing definitions (e.g., gaps in supply, dosage reductions) versus chart review using sensitivity and specificity.
RESULTS: Among 257 patients in the overall sample, 44% were aged 66-74 years, 35% had Medicare low-income subsidy, 79% were female. Among claims-based definitions using gaps in supply, the prevalence of BZD deprescribing ranged from 8.2% (no refills) to 36.6% (30-day gap). When incorporating dosage, the prevalence ranged from 55.3% to 65.8%. Among the validation sub-sample (n = 47), approximately one-third had BZDs deprescribed in the EHR. Compared to EHR, gaps in supply from claims had good sensitivity, but poor specificity. Incorporating dosage increased sensitivity, but worsened specificity.
CONCLUSIONS: The sensitivity of claims-based definitions for deprescribing of BZDs was low; however, the specificity of a 90-day gap was >90%. Replication in other EHRs and for other low-value medications is needed to guide future deprescribing research.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Pharmacoepidemiology and drug safety - 33(2024), 4 vom: 08. Apr., Seite e5784 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Niznik, Joshua D [VerfasserIn] |
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| Links: |
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| Themen: |
12794-10-4 |
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| Anmerkungen: |
Date Completed 02.04.2024 Date Revised 02.04.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1002/pds.5784 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM370463552 |
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| 520 | |a © 2024 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Limited research has evaluated the validity of claims-based definitions for deprescribing | ||
| 520 | |a OBJECTIVES: Evaluate the validity of claims-based definitions of deprescribing against electronic health records (EHRs) for deprescribing of benzodiazepines (BZDs) after a fall-related hospitalization | ||
| 520 | |a METHODS: We used a novel data linkage between Medicare fee-for-service (FFS) and Part D with our health system's EHR. We identified patients aged ≥66 years with a fall-related hospitalization, continuous enrollment in Medicare FFS and Part D for 6 months pre- and post-hospitalization, and ≥2 BZD fills in the 6 months pre-hospitalization. Using a standardized EHR abstraction tool, we adjudicated deprescribing for a sub-sample with a fall-related hospitalization at UNC. We evaluated the validity of claims-based deprescribing definitions (e.g., gaps in supply, dosage reductions) versus chart review using sensitivity and specificity | ||
| 520 | |a RESULTS: Among 257 patients in the overall sample, 44% were aged 66-74 years, 35% had Medicare low-income subsidy, 79% were female. Among claims-based definitions using gaps in supply, the prevalence of BZD deprescribing ranged from 8.2% (no refills) to 36.6% (30-day gap). When incorporating dosage, the prevalence ranged from 55.3% to 65.8%. Among the validation sub-sample (n = 47), approximately one-third had BZDs deprescribed in the EHR. Compared to EHR, gaps in supply from claims had good sensitivity, but poor specificity. Incorporating dosage increased sensitivity, but worsened specificity | ||
| 520 | |a CONCLUSIONS: The sensitivity of claims-based definitions for deprescribing of BZDs was low; however, the specificity of a 90-day gap was >90%. Replication in other EHRs and for other low-value medications is needed to guide future deprescribing research | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Thorpe, Carolyn T |e verfasserin |4 aut | |
| 700 | 1 | |a Hanson, Laura C |e verfasserin |4 aut | |
| 700 | 1 | |a Rice, Colleen |e verfasserin |4 aut | |
| 700 | 1 | |a Lund, Jennifer L |e verfasserin |4 aut | |
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