Visualizing patterns of asthma medication prescribing in ... · Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 1 23 May 2012 May-27-12 ... • Appropriate LABA Prescribing-

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 1 23 May 2012

Visualizing patterns of asthma medication prescribing in the Military

Health System using EventFlow

Tamra Meyer1, Megan Monroe2, Jeff Millstein3, Suji Xie1, Trinka Coster1

1Pharmacovigilance Center, Office of the Surgeon General, Department of the Army; 2 University of Maryland, Computer Science and HCIL; 3Oracle Health Sciences

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 2 23 May 2012

Research Question

Are LABAs being misprescribed in the MHS?

• Appropriate LABA Prescribing- Ordered Patterns –  LABA only in conjunction with ICS = LABA/ICS –  Step-up or step down therapy

• SABA step-up to ICS step-up to LABA/ICS •  LABA/ICS step down to ICS and/or SABA

Acronym Alert ICS: Inhaled Corticosteroid LABA: Long-acting Beta Agonist MHS: Military Health System SABA: Short-acting Beta-Agonist

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 3 23 May 2012

9.5 million people have

access to benefits

MHS Population

Family member of retired or survivor

Family member of active duty,

guard, reserves

Active duty, guard, reserves

Retired from active duty,

guard, reserves

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 4 23 May 2012

SOURCES REPOSITORY

MHS Data Repository

EHR

ELIGIBILITY/ ENROLLMENT

ADMIN CLAIMS

PHARMACY RECORDS

110 HOSTS

DATA MART

PII preprocessor

PHARMACOVIGILANCE DEFENSE APPLICATION

SYSTEM (PVDAS)

Data Source

Acronym Alert EHR: Electronic Health Record PII: Personally Identifiable Information

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 5 23 May 2012

Methods

Extract asthma medications

surrounding LABA Rx

174,238 Asthma

patients with a new LABA Rx

100 patients

ID Group Start End

1333 LABA_ICS 2006-01-13 2006-02-11

1333 LABA_ICS 2006-02-05 2006-03-05

1333 LABA_ICS 2006-03-03 2006-04-01

1333 SABA 2006-03-03 2006-04-01

1333 ICS 2006-04-01 2006-04-30

1333 ICS 2006-05-01 2006-05-30

1718 SABA 2008-06-23 2008-07-22

1718 ICS 2009-02-10 2009-03-10

1718 LABA_ICS 2009-02-24 2009-03-24

Categorize into groups and process

file for EventFlow

Jan 2006-Jan 2011

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 6 23 May 2012

EventFlow: Ordered Patterns Are Combined

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 7 23 May 2012

All Asthma Drugs

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 8 23 May 2012

Align on First LABA-ICS

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 9 23 May 2012

View LABA and ICS Only

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 10 23 May 2012

LABA and ICS in Those Who Started With LABA Alone

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 11 23 May 2012

EventFlow Summary

• Simple data structure •  Intuitive display • Alignment tool was very powerful-quickly and easily

identified possible patterns of suboptimal LABA prescribing • Scaling up to larger samples is critical

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May-27-12 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address Slide 12 23 May 2012

The Army’s Home for Health… Saving Lives and Fostering Healthy and Resilient People

~ Partnerships Built on Trust