Michaud Veronique, Smith Matt K, Bikmetov Ravil, Dow Pamela, Johnson Joshua, Stein Alan, Finnel Stephanie, Jin Huaichuan, Turgeon Jacques
Tabula Rasa HealthCare, Orlando, FL, and Université de Montréal, Montréal, Québec, Canada, 13485 Veterans Way, Ste 410, Orlando, FL 32827. Email:
Am J Manag Care. 2021 Sep;27(16 Suppl):S280-S291. doi: 10.37765/ajmc.2021.88753.
Older patients are especially vulnerable to drug-related problems due to multiple prescription drugs, which increases their risk of drug-drug interactions and adverse drug events (ADEs). This study aimed to examine outcomes associated with the MedWise Risk Score (MRS) in a Medicare Part D population, including total medical expenditures, ADEs, falls, mortality, emergency department (ED) visits, hospital admissions, and length of stay (LOS).
Retrospective observational study.
The association between MRS and patient health outcomes was derived using drug claims data from 213,561 beneficiaries and medication risk stratification using outcomes data in 2018 with 1 year of follow-up. Analyses were conducted with the Max MRS and the Mean MRS calculated over the year. Analyses utilizing the Max MRS performed better, and results using the Max MRS are presented. Statistical analyses were performed using linear regression, logistic regression, negative binomial regression, and zero-inflated Poisson (ZIP) models.
Of 203,630 patients studied (mean ± SD age, 76.0 ± 8.0 years), 4.9%, 9.8%, 24.5%, and 15.5% experienced at least 1 ADE, fall, ED visit, and hospital admission, respectively, in 2018. The MRS was associated with an 8.5% change in total medical expenditure per 1-unit increase. The adjusted odds ratio (OR) of ADE was 1.058 (95% CI, 1.055-1.06)/unit MRS. ADEs, falls, and death were more likely in elevated MRS categories (eg, OR of 4.45 for ADEs [95% CI, 4.10-4.83], 5.51 for falls [95% CI, 5.17-5.87], and 4.42 for death [95% CI, 3.82-5.12], respectively forSevere MRS group). Our model predicts 7000 ED visits for every 100,000 patients per unit increase of the MRS. The ZIP models estimated ORs of 1.03 and 1.01 for hospital admissions and increase in hospital LOS, respectively, per MRS unit.
This study shows that MRS was associated with health outcomes and therefore could be used to identify patients at increased risk of negative outcomes based primarily on their medication regimens.
老年患者因服用多种处方药，特别容易出现与药物相关的问题，这增加了他们发生药物相互作用和药物不良事件（ADEs）的风险。本研究旨在调查医疗保险D部分人群中与MedWise风险评分（MRS）相关的结果，包括总医疗费用、ADEs、跌倒、死亡率、急诊科（ED）就诊、住院和住院时间（LOS）。
回顾性观察研究。
利用213,561名受益人的药物报销数据得出MRS与患者健康结果之间的关联，并使用2018年的结果数据进行药物风险分层，随访1年。对全年计算的最大MRS和平均MRS进行分析。利用最大MRS的分析表现更好，现展示使用最大MRS的结果。使用线性回归、逻辑回归、负二项回归和零膨胀泊松（ZIP）模型进行统计分析。
在研究的203,630名患者中（平均年龄±标准差，76.0±8.0岁），2018年分别有4.9%、9.8%、24.5%和15.5%的患者经历了至少1次ADEs、跌倒、ED就诊和住院。MRS每增加1个单位，总医疗费用变化8.5%。ADEs的调整优势比（OR）为1.058（95%CI，1.055 - 1.06）/单位MRS。MRS类别升高时，ADEs、跌倒和死亡的可能性更大（例如，严重MRS组中ADEs的OR为4.45 [95%CI，4.10 - 4.83]，跌倒的OR为5.51 [95%CI，,5.17 - 5.87]，死亡的OR为4.42 [95%CI，3.82 - 5.12]）。我们的模型预测，MRS每增加1个单位，每100,000名患者中有7000次ED就诊。ZIP模型估计，MRS每增加1个单位，住院和住院LOS增加的OR分别为1.03和1.01。
本研究表明，MRS与健康结果相关，因此可用于主要根据患者的用药方案识别负面结果风险增加的患者。
