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BACKGROUND/RATIONALE:
The Institute of Medicine identified prevention and recognition of drug-related problems in the elderly as principal health care safety issues for this decade. In order to reduce the magnitude of drug-related problems, interventions targeting the patient, provider, and healthcare system will be needed. However, successful interventions cannot be developed without valid definitions of potentially inappropriate prescribing in the elderly (PIPE). The National Committee on Quality Assurance has defined PIPE using two measures incorporated into future Health Plan Employer Data and Information Sets (HEDIS): specific drugs to avoid (hereafter 2006 HEDIS PIPE), and clinically relevant drug-disease interactions (hereafter 2007 HEDIS PIPE). However, the literature finds that evidence linking PIPE exposure using similar measures to adverse patient outcomes is inconsistent at best. For the 2007 HEDIS PIPE measure, evidence is not yet available; for the 2006 measure, lack of evidence is due to either methodological limitations of prior studies, or to an insufficient link between these measures and patient outcomes.
OBJECTIVE(S):
VA's rich databases allow us to mitigate limitations of prior studies and address three specific objectives:
Objective 1: Assess the association between the 2006 and 2007 HEDIS PIPE exposure and general outcomes measures (e.g., mortality, time to hospitalization/ emergency care).
Objective 2: Assess the association between the 2006 and 2007 HEDIS PIPE exposure and patient outcomes more specific to PIPE such as fall-related injuries.
Objective 3: Develop PIPE-specific utilization measures and assess their association with 2006 and 2007 HEDIS PIPE measures.
METHODS:
We will develop two cohorts (FY04 and FY05) with incident PIPE exposure among veterans who are 65 years and older. We will merge VA administrative and pharmacy data with Medicare data (FY03-FY06) to comprehensively assess outcomes for 12 months following initial PIPE exposure. We will conduct hierarchical multivariable regression analyses to assess the relationship of 2006 and 2007 HEDIS PIPE measures with patient outcomes. To minimize confounding, analyses will control for patient clinical characteristicsespecially disease burden. Secondary analyses such as assessing the relationship between specific therapeutic drug classes (e.g., antihistamines, opiates, etc.) will allow us an opportunity to refine the current HEDIS PIPE measures if we find little or no relationship between exposure and patient outcomes.
FINDINGS/RESULTS:
Results are pending final cohort identification.
IMPACT:
The findings from this study have three major areas of impact. First, they will provide policy makers within and outside VA the evidence that will allow them to determine whether or not to adopt new quality measures of inappropriate prescribing for the elderly. Second, they will provide evidence that clinicians can use when making prescribing decisions for older veterans. Finally, the proposed project will provide new methods for measuring and monitoring inappropriate prescribing in the elderly that can be 1) used with current measures if analyses support their validity or 2) adapted to new evidence-based measures evolving from the results of this study.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Epidemiology, Quality of Care
Keywords:
none
MeSH Terms:
none
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