Abstract：
BACKGROUND: Comprehensive medication management (CMM) programs optimize the effectiveness and safety of patients\' medication regimens, but CMM may be underutilized. Whether healthcare claims data can identify patients appropriate for CMM is not well-studied.
OBJECTIVE: Determine the face validity of a claims-based algorithm to prioritize patients who likely need CMM.
METHODS: We used claims data to construct patient-level markers of \"regimen complexity\" and \"high-risk for adverse effects,\" which were combined to define four categories of claims-based CMM-need (very likely, likely, unlikely, very unlikely) among 180 patient records. Three clinicians independently reviewed each record to assess CMM need. We assessed concordance between the claims-based and clinician-review CMM need by calculating percent agreement as well as kappa statistic.
RESULTS: Most records identified as \'very likely\' (90%) by claims-based markers were identified by clinician-reviewers as needing CMM. Few records within the \'very unlikely\' group (5%) were identified by clinician-reviewers as needing CMM. Interrater agreement between CMM-based algorithm and clinician review was moderate in strength (kappa = 0.6, p < 0.001).
CONCLUSIONS: Claims-based pharmacy measures may offer a valid approach to prioritize patients into CMM-need groups. Further testing of this algorithm is needed prior to implementation in clinic settings.
OBJECTIVE: Determine the face validity of a claims-based algorithm to prioritize patients who likely need CMM.
METHODS: We used claims data to construct patient-level markers of \"regimen complexity\" and \"high-risk for adverse effects,\" which were combined to define four categories of claims-based CMM-need (very likely, likely, unlikely, very unlikely) among 180 patient records. Three clinicians independently reviewed each record to assess CMM need. We assessed concordance between the claims-based and clinician-review CMM need by calculating percent agreement as well as kappa statistic.
RESULTS: Most records identified as \'very likely\' (90%) by claims-based markers were identified by clinician-reviewers as needing CMM. Few records within the \'very unlikely\' group (5%) were identified by clinician-reviewers as needing CMM. Interrater agreement between CMM-based algorithm and clinician review was moderate in strength (kappa = 0.6, p < 0.001).
CONCLUSIONS: Claims-based pharmacy measures may offer a valid approach to prioritize patients into CMM-need groups. Further testing of this algorithm is needed prior to implementation in clinic settings.
摘要：
背景：综合用药管理（CMM）计划优化了患者用药方案的有效性和安全性，但是CMM可能没有得到充分利用。医疗保健索赔数据是否可以识别适合CMM的患者还没有得到很好的研究。
目的：确定基于索赔的算法的面部有效性，以优先考虑可能需要CMM的患者。
方法：我们使用索赔数据来构建“方案复杂性”和“不良反应高风险”的患者水平标志物，“将其组合起来定义了四类基于索赔的CMM需求(很可能，很可能,不太可能，非常不可能)在180个病人记录中。三名临床医生独立审查了每个记录以评估CMM需求。我们通过计算百分比一致性以及kappa统计量来评估基于索赔的CMM和临床医师审查CMM需求之间的一致性。
结果：由基于索赔的标记鉴定为“非常可能”（90％）的大多数记录都被临床医生鉴定为需要CMM。“非常不可能”组（5％）中很少有记录被临床医生-审查员确定为需要CMM。基于CMM的算法和临床医生评价之间的评分者之间的一致性是中等强度的(kappa=0.6,p<0.001)。
结论：基于权利要求的药学措施可能提供一种有效的方法，将患者分为需要CMM的组。在临床设置中实施之前,需要进一步测试该算法。
目的：确定基于索赔的算法的面部有效性，以优先考虑可能需要CMM的患者。
方法：我们使用索赔数据来构建“方案复杂性”和“不良反应高风险”的患者水平标志物，“将其组合起来定义了四类基于索赔的CMM需求(很可能，很可能,不太可能，非常不可能)在180个病人记录中。三名临床医生独立审查了每个记录以评估CMM需求。我们通过计算百分比一致性以及kappa统计量来评估基于索赔的CMM和临床医师审查CMM需求之间的一致性。
结果：由基于索赔的标记鉴定为“非常可能”（90％）的大多数记录都被临床医生鉴定为需要CMM。“非常不可能”组（5％）中很少有记录被临床医生-审查员确定为需要CMM。基于CMM的算法和临床医生评价之间的评分者之间的一致性是中等强度的(kappa=0.6,p<0.001)。
结论：基于权利要求的药学措施可能提供一种有效的方法，将患者分为需要CMM的组。在临床设置中实施之前,需要进一步测试该算法。
