Ratigan Amanda Rondinelli, Michaud Veronique, Turgeon Jacques, Bikmetov Ravil, Gaona Villarreal Gabriela, Anderson Heather D, Pulver Gerald, Pace Wilson D
From the DARTNet Institute, Aurora, Colorado.
Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Lake Nona, Orlando, Florida.
J Patient Saf. 2021 Jun 1;17(4):249-255. doi: 10.1097/PTS.0000000000000829.
The use of electronic health records allows for the application of a novel medication risk score for the rapid identification of ambulatory patients at risk of adverse drug events. We sought to examine the longitudinal association of medication risk score with mortality. This retrospective cohort study included patients whose data were available through electronic health records from multiple health care organizations in the United States that provided data as part of a Patient Safety Organization. Patients were included if they had ≥1 visit and ≥1 medication in their record between January 1, 2011, to June 30, 2017. Cox proportional hazards regression was used to examine the association between continuous and categorized medication risk score with all-cause mortality. Among 427,103 patients, the median age was 50 years (interquartile range, 29-64 years); 61% were female; 50% were White, 11% were Black, and 38% were Hispanic; and 6873 had a death date recorded. Patients 30 to 49 years old had the highest hazard ratios (HRs), followed by the 50- to 64-year-olds and lastly those 65 years or older. Controlling for all covariates, 30- to 49-year-olds with a score of 20 to 30 (versus <10) had a 604% increase in the hazard of death (HR, 7.04; 95% confidence interval [CI], 3.86-12.85), 50- to 64-year-olds had a 254% increase (HR, 3.54; 95% CI, 2.71-4.63), and ≥65-year-olds had an 87% increase (HR, 1.87; 95% CI, 1.67-2.09). The medication risk score was independently associated with death, adjusting for multimorbidities and other conditions. Risk was found to vary by age group and score. Results suggest that pharmaceutical interventions among those with elevated scores could improve medication safety for patients taking multiple medications.
使用电子健康记录有助于应用一种新型药物风险评分，以快速识别有药物不良事件风险的门诊患者。我们试图研究药物风险评分与死亡率之间的纵向关联。这项回顾性队列研究纳入了通过美国多个医疗保健机构的电子健康记录获取数据的患者，这些机构作为患者安全组织的一部分提供数据。如果患者在2011年1月1日至2017年6月30日期间有≥1次就诊记录且记录中有≥1种药物，则纳入研究。采用Cox比例风险回归分析连续和分类药物风险评分与全因死亡率之间的关联。在427,103名患者中，中位年龄为50岁（四分位间距为29 - 64岁）；61%为女性；50%为白人，11%为黑人，38%为西班牙裔；6873人有死亡日期记录。30至49岁的患者风险比（HR）最高，其次是50至64岁的患者，最后是65岁及以上的患者。在控制所有协变量后，评分在20至30分（对比<10分）的30至49岁患者死亡风险增加604%（HR，7.04；95%置信区间[CI]，3.86 - 12.85），50至64岁患者增加254%（HR，3.54；95% CI，2.71 - 4.63），≥65岁患者增加87%（HR，1.87；95% CI，1.67 - 2.09）。药物风险评分与死亡独立相关，在调整多种疾病和其他情况后依然如此。发现风险因年龄组和评分而异。结果表明，对评分较高者进行药物干预可提高服用多种药物患者用药的安全性。
