Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data.
Am J Manag Care
; 10(11 Pt 1): 783-90, 2004 Nov.
Article
em En
| MEDLINE
| ID: mdl-15623267
ABSTRACT
OBJECTIVES:
To develop a systems approach to identify, for further evaluation, patients with potential controlled substance misuse or mismanagement using software queries applied to administrative health claims data. STUDYDESIGN:
Retrospective validation of the system using insurance claims. PATIENTS ANDMETHODS:
Data from administrative health claims databases representing nearly 7 million individuals younger than 65 years were used by multidisciplinary expert panels to develop and validate controlled substance patterns of utilization requiring evaluation (CS-PURE) criteria.RESULTS:
Thirty-four CS-PURE queries were developed in SAS and applied to administrative claims records to identify patients with potential controlled substance misuse or mismanagement. From these, we identified 10 CS-PURE with the highest expert agreement that intervention was warranted. Expert panel agree, ment that CS-PURE correctly identified cases ranged from 48% to 100%, with at least 50% agreement in 9 of 10 CS-PURE. The prevalence rates for CS-PURE ranged from 0.001% to 0.252%. This translates to identifying between 5 and 1116 patients for individual CS-PURE in a 500 000-member health plan.CONCLUSIONS:
We developed and empirically validated a group of queries using CS-PURE to identify patients with potential controlled substance misuse or mismanagement that would warrant further evaluation by the treating physician, a quality assurance function, or the medical director. Claims-based CS-PURE identification is generalizable to most health insurers with access to medical and pharmaceutical claims records. Although CS-PURE are not direct measures of misuse, they can direct attention to potential problems to determine if intervention is needed.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Dor
/
Revisão da Utilização de Seguros
/
Reconhecimento Automatizado de Padrão
/
Sistemas de Informação em Farmácia Clínica
/
Revisão de Uso de Medicamentos
/
Transtornos Relacionados ao Uso de Substâncias
/
Controle de Medicamentos e Entorpecentes
Tipo de estudo:
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Humans
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2004
Tipo de documento:
Article