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.
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。