Pharmacy & Therapeutics - February 2009 - (Page 82)

Asthma Utilization Rx Analyzer (AURA) Tool With AURA, pharmacy and medical claims data are imported, integrated, and analyzed in accordance with the userdefined customizable options and utilization measures (Table 1). Furthermore, the user can modify the definition of persistent asthma based on the number of emergency department visits, hospitalizations, outpatient visits, and medicationdispensing events. The results are then displayed concurrently according to persistent and non-persistent asthma in comparison with a reference data set (the option of either PharMetrics or a plan-specific reference). The following are examples of utilization measures available in the software tool. at least one controller prescription and the average number of controller medications by quarter are also reported. Emergency Visits, Outpatient Visits, and Hospital Stays AURA provides the total number of asthma-related emergency department (ED) visits, outpatient visits, and inpatient hospitalizations, as defined by Current Procedural Terminology (CPT) codes and Uniform Billing (UB-92) revenue codes (Table 2). The presence of a diagnosis code for asthma (ICD9 493.x) defines an asthma-related visit. The tool also reports the number of members with each visit type as well as the number of asthma-related pharmacy claims filled within specific time intervals (e.g., 1 to 30 days) prior to each visit type. The asthma-related pharmacy claims are further categorized by medication type (controller or rescue) and by therapeutic class and generic category. Results are presented for the two asthma severity subgroups (persistent and non-persistent). Short-Acting Beta-Agonists and Steroids Because rescue medications (SABAs, oral steroids) are typically used for managing acute asthma episodes rather than for long-term control, an increased use of these drugs generally indicates poor disease control. Inappropriate use of SABAs (i.e., more than four canisters per year) has been correlated with poor asthma control and with a risk of hospitalization.23 The use of SABAs in AURA is calculated and is reported based on the number of patients with one to seven or more SABA claims. Details of the actual SABA medications used are provided for patients receiving seven or more SABA claims. Similarly, oral steroid use is reported based on the number of patients with at least one steroid pulse prescription claim and details of the actual medications used. All results are displayed in tabular and graphical formats. Other Utilization Measure Criteria AURA provides information about the cost of asthma for each health plan member per month as well as the average monthly cost for each plan member with a diagnosis of asthma according to medical and pharmacy claims. This cost information is depicted in summary format as well as on a monthly basis over time during the measurement period. Medical care costs (e.g., for hospitalization, emergency, or outpatient visits) and prescription costs are displayed in a tabular format. AURA can produce measures of performance by targeting patients with high use of resources and physicians whose patients are less than optimally managed. By applying threshold definitions, the high use of medical resources (i.e., emergency or hospitalization events), high use of rescue medications, and low use of controller medications can be specified and assessed. AURA also reports identification numbers of prescribers along with the proportion of their patients who were above or below the specified threshold. Controller Medications Along with the evaluation of rescue medications, patterns of controller medication use can indicate how well asthma is being managed within the health plan. Controller medications, such as inhaled corticosteroids, long-acting bronchodilators, leukotriene receptor antagonists, combination products, and mast-cell stabilizers, are shown by the percentage of use and by disease severity (persistent and non-persistent asthma). This figure is determined by using the number of claims for specific controller medications (by class, by drug, or by strength), divided by the total number of claims for controller medications. Among patients with persistent asthma, the total quarterly claims for the number and proportion of patients with UTILITY AND APPLICATION OF AURA Poorly controlled asthma treatment can lead to increased use of resources and increased costs of care. AURA helps in determining patterns of usage to identify ways to improve quality. The following examples demonstrate how the tool can Table 2 Codes for Identifying Type of Visit by Patients with Asthma* Description Outpatient Current Procedural Terminology 99201–99205, 99211–9215, 99217–99220, 99241–99245, 99341–99345, 99347–99350, 99382–99386, 99392–99396,99401–99404, 99411, 99412, 99420, 99429, 99499 99221–99223, 99231–99233, 99238, 99239, 99251–99255, 99261–99263, 99291 99281–99285 Uniform Billing UB-92 Revenue Code 051x, 052x, 057x–059x, 077x, 0982, 983 Acute inpatient 010x, 0110-0114, 0119, 0120–0124, 0129, 0130–0134, 0139, 0140–0144, 0149, 0150– 0154, 0159, 016x, 020x–022x, 072x, 0987 045x, 0981 Emergency * HEDIS 2007,Vol 2. National Committee for Quality Assurance.7 82 P&T® • February 2009 • Vol. 34 No. 2

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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