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. 2020 May 20;8(2):87.
doi: 10.3390/pharmacy8020087.

Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly

David L Bankes  1 , Hubert Jin  2 , Stephanie Finnel  2 , Veronique Michaud  3 , Calvin H Knowlton  4 , Jacques Turgeon  3 , Alan Stein  2
Affiliations

Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly

David L Bankes et al. Pharmacy (Basel). .

Abstract

Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity.

Keywords: PACE; Programs of All-Inclusive Care for the Elderly; adverse drug events; medical expenditures; medicare; medication risk stratification; risk score.

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Conflict of interest statement

All authors performed this work as employees (with stock options and shares) of Tabula Rasa HealthCare (d/b/a CareKinesis). The authors have no personal conflicts to disclose.

Figures

Figure A1
Figure A1
Receiver operator characteristic curve for adverse drug events.
Figure 1
Figure 1
Data management and workflow diagram.
Figure 2
Figure 2
Distribution of MedWise Risk Score™ among PACE participants. Abbreviations: PACE: Programs of All-Inclusive Care for the Elderly.
Figure 3
Figure 3
Weighted regression showing relationship between the MedWise Risk Score™ and participants with ≥1 adverse drug event.
Figure 4
Figure 4
Weighted regression showing relationship between MedWise Risk Score™ and total annual (2018) medical costs in the total population.
Figure 5
Figure 5
Weighted regression showing relationship between MedWise Risk Score™ and emergency department visits in the total population.
Figure 6
Figure 6
Weighted regression showing relationship between MedWise Risk Score™ and hospital admissions in the total population.
Figure 7
Figure 7
Weighted regression showing relationship between MedWise Risk Score™ and hospital length of stay in the total population.
See this image and copyright information in PMC

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