Development and validation of a medication intensity scale derived from computerized pharmacy data that predicts emergency hospital utilization for persistent asthma.

Michael Schatz; Robert S Zeiger; William M Vollmer; David Mosen; Andrea J Apter; Thomas B Stibolt; Albin Leong; Michael S Johnson; Guillermo Mendoza; E Francis Cook

PubMed · 16886890

Development and validation of a medication intensity scale derived from computerized pharmacy data that predicts emergency hospital utilization for persistent asthma.

Michael Schatz·Robert S Zeiger·William M Vollmer·David Mosen·Andrea J Apter·Thomas B Stibolt·Albin Leong·Michael S Johnson·Guillermo Mendoza·E Francis Cook

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Abstract

OBJECTIVE: To validate a risk stratification scheme using computerized pharmacy data to predict emergency hospital utilization for persistent asthma. STUDY DESIGN: Retrospective cohort. METHODS: The development sample consisted of 1079 HMO members aged 18 to 56 years with persistent asthma. The scale used medication cut-points as predictors for next-year emergency hospital utilization in a stepwise logistic regression model. Prediction properties were evaluated in a validation sample of 24 370 patients aged 18 to 56 years in a separate persistent-asthma database. RESULTS: Increasing use of beta-agonists (odds ratio [OR] of 2.2 for 5-13 vs 0-4 canisters; OR of 2.4 for >13 vs 5-13 canisters) and oral corticosteroids (OR of 2.6 for >2 vs 0-2 dispensing events) in the first year independently predicted emergency hospital utilization in the second year. Assigning 1 point for exceeding each of the above 3 medication thresholds led to a 4-level medication intensity scale that was significantly (P <.0001) related to validated measures of asthma symptom severity, asthma control, and asthma quality of life in the development sample. In the validation sample, this scheme identified a high-risk group that was 6 times more likely than the low-risk group to require subsequent emergency hospital care, with overall sensitivity of 65% and specificity of 54%. This scale did not perform as well as a scale based on both baseline emergency hospital care and pharmacy data. CONCLUSION: This simple risk stratification scheme can be used for populations with persistent asthma for whom computerized pharmacy data, but not computerized prior utilization data, are available.

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Adolescent Adult Anti-Asthmatic Agents Asthma Chronic Disease Cohort Studies Emergency Service, Hospital Female Humans Male Medical Records Systems, Computerized Middle Aged Pacific States Pharmaceutical Services Retrospective Studies Journal Article Research Support, Non-U.S. Gov't Validation Study

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Michael Schatz, Robert S Zeiger, William M Vollmer, David Mosen, Andrea J Apter, Thomas B Stibolt, Albin Leong, Michael S Johnson, Guillermo Mendoza, E Francis Cook. 2006. Development and validation of a medication intensity scale derived from computerized pharmacy data that predicts emergency hospital utilization for persistent asthma.. https://pubmed.ncbi.nlm.nih.gov/16886890/

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