Comparing and validating medication complexity from insurance claims against electronic health records

• DOI: 10.18553/jmcp.2022.28.4.473
• Publication Date: 2022-03-25T12:29:45Z
• Authors: Christopher A Kit...; Hsien-Yen Chang; Martin A Bishop; Kenneth M Shermock; Hadi Kharrazi; Jonathan P Weiner
• Keywords: Concordance; Medication therapy management; Medical record; Medicare Advantage

BACKGROUND: Patient effort to comply with complex medication instructions is known be related nonadherence and subsequent medical complications or health care costs. A widely used Medication Regimen Complexity Index (MRCI) has been electronic records (EHRs) identify patients who could benefit from pharmacist intervention. similar claims-derived measure may better suited for clinical decision support, since claims offer a more complete view of patient utilization. OBJECTIVE: To define validate novel insurance claims-based complexity score (MCS) patterned after the MRCI, derived EHRs. METHODS: Insurance EHR data were provided by HealthPartners (N = 54,988) (Bloomington, Minnesota) The Johns Hopkins Health System 28,589) (Baltimore, Maryland) years 2013 2017, respectively. Yearly measures developed each evaluated one another using rank correlation within different subgroupings. Indicators presence individually prescriptions also assessed exact agreement. then correlated select covariates further concordance between MCS MRCI respect metrics. These included demographic, comorbidity, utilization markers. Prescribed medications in system's coded previously validated weighting rules. retail pharmacy our MCS, which closely followed scoring RESULTS: EHR-based significantly most Likewise, both several covariates, including count active chronic conditions. was, cases, associated key than was although consistently significant. We found that highest obtained have counts EHRs (HealthPartners: P 0.796; System: 0.779). CONCLUSIONS: findings suggest good correspondence represent useful resource assessing complexity. Claims major practical advantages, such as interoperability across systems, they lack detailed context DISCLOSURES: University holds copyright Adjusted Clinical Groups (ACG) system receives royalties global distribution ACG system. This revenue supports portion authors' salary. No additional external funding supported this work. authors no conflict interest disclose.