Pharmacy & Therapeutics - February 2009 - (Page 81)

Asthma Utilization Rx Analyzer (AURA) Tool Because repeated measurements are necessary in ongoing quality programs, AURA incorporates and automates utilization measure criteria (UMC) in its system to increase efficiency in data analysis. AURA also of fers flexibility by providing users with options throughout the tool. Users have the choice to analyze all patients or to evaluate specific patient subpopulations, such as patients with persistent or non-persistent asthma, and pediatric or adult patients. In addition, users have the option to analyze all available measures or to pick and choose specific ones. For many of the measures, users can further customize the tool by selecting a preferred definition from a list of available options. For benchmarking, AURA includes a pre-loaded default reference set of results based on data from PharMetrics (Watertown, Mass.), an integrated national claims database. PharMetrics is composed of more than 85 managed health care plans encompassing 45 million members. In addition to the preloaded default reference, AURA users can create and store up to three plan-specific references within the tool to track their plan’s quality metrics over time. vide detailed definitions for the selected asthma measures. The software design phase began with the selection of a Microsoft.NET platform utilizing a database back-end to store and retrieve claims. An alpha version was developed with basic functionality and screen design, followed by a beta version with full functionality. Using the beta version, we conducted validation testing to ensure quality control and the accuracy, reliability, and validity of results. Validation testing included assessments of output and of the functionality of the tool itself. We tested the output results through a database analysis using SAS version 9.1 (Cary, N.C.). We evaluated software functionality through unit testing, system integration testing, and a formal quality assurance test. All identified errors and inconsistencies were tracked and resolved. The last phase included pilot testing with the end-user. We selected a total of three sites: a Medicaid health plan, a commercial health plan, and a large provider organization. Each site utilized their own data to test the tool and provided feedback about the usefulness of the tool along with suggested enhancements. We recorded all feedback and updated the tool. Specific Utilization Measure Criteria Approach to AURA Development and Methodology A five-step process was used to develop AURA: • • • • • a literature review development of UMC software design validation testing pilot testing Health plans are often evaluated based on benchmarks and are held accountable to asthma-reporting metrics. HEDIS, for example, contains a performance measure that focuses on asthma care.7 In HEDIS, the quality of asthma care is measured based on the proportion of patients with persistent asthma who are receiving an appropriate long-term controller medication. AURA automates the process and extends the asthma-related reporting capability beyond controller medication use alone. First, we conducted a literature search and review to obtain and assimilate key asthma-related guidelines, quality metrics, benchmark reports, posters, publications, and presentations. We reviewed publications from the American Lung Association (ALA); the National Center for Health Statistics; the Centers for Disease Control and Prevention (CDC); the National Heart, Lung and Blood Institute; the National Committee for Quality Assurance (NCQA); and the American Academy of Allergy, Asthma, and Immunology (AAAAI). The rationale for AURA emerged from ALA3 and AAAAI.11 We consulted numerous additional publications to establish the criteria for defining persistent asthma within AURA.12–17 As a result of the varying criteria found in the literature, the tool was designed to enable users to choose any one or a combination of four customizable criteria adopted from NCQA.7 Findings from the literature were also used to define comorbid conditions of interest,12,13,18–22 drug compliance measures,14,16,17,19–21 and the utilization of asthma-related resources, including hospitalizations, emergency department visits, and use of oral corticosteroids and short-acting beta-agonists (SABAs).14,16,19–23 From this information, we compiled a list of asthma-related measures of interest and their proposed definitions in the outline of the UMC document. We then used a national health plan claims database (PharMetrics) to evaluate the asthma metrics and to test the feasibility of analyzing health plan claims data according to the UMC outline. After feasibility testing and measure refinement, the UMC document was created to briefly explain the purpose and content of the software tool and to pro- Table 1 Customizable Utilization Measures Population overview Patient demographics Comorbid conditions Asthma drugs with a non-asthma diagnosis (0 to 4 years of age) Controller medications Utilization by asthma severity Average days’ supply Rescue medications Use of short-acting beta-agonists Use of pulse steroids Compliance with controller medications Use of controller medications by health plan members with persistent asthma by quarter Average number of controller medication claims by quarter Resource utilization Emergency department visits Hospitalization Outpatient visits Costs Average asthma spending per member per month Average asthma spending per member per month detail Vol. 34 No. 2 • February 2009 • P&T® 81

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - February 2009

Pharmacy & Therapeutics - February 2009 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/New Medical Devices Drug Forecast Pushing an Expanded Role for Pharmacists Better Asthma Management with Advanced Technology Pharmaceutical Approval Update 58th Annual Meeting, American Society of Human Genetics, 2008 American Society of Hematology, 50th Annual Meeting and Exposition 2008 San Antonio Breast Cancer Symposium Stahl’s Essential Psychopharmacology, 3rd Edition Author Guidelines

Pharmacy & Therapeutics - February 2009

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