Rosa L. Cabanela

How Well Does Patient Self-Report Predict Asthma Medication Possession? Implications for Medication Reconciliation and Adherence Assessment

Background. Self-report is the most commonly used method for collecting information regarding asthma medication possession and adherence in clinical practice. Objective. To determine the agreement between self-report and pharmacy claims data for asthma medication possession. Methods. This is a retrospective study that examined pharmacy claims data 12 months before and after participants completed a structured asthma survey. This study was performed in a sample of health care workers and dependents >17 years old in a large, self-insured Midwestern United States health care center. The main outcome measure was agreement (kappa calculation) between self-report and pharmacy claims data of asthma medication possession. Results. Self-report of asthma medication use agreed moderately with pharmacy claims data for short-acting albuterol (κ = 0.47 ± 0.03), salmeterol (κ = 0.79 ± 0.04), and montelukast (κ = 0.69 ± 0.03) but only slightly for inhaled corticosteroids (κ = 0.18 ± 0.03) and prednisone (κ = 0.10 ± 0.03) (n = 1050 respondents). Both under self-reporting and over self-reporting were common with inhaled corticosteroids (14.4% and 23.1%, respectively) and varied significantly by specific drug type. Conclusions. Self-report moderately agrees with asthma medication possession for most adult asthma patients, though the agreement differs considerably between and within asthma medication classes.

Comparison of provider claims data versus medical records review for assessing provision of adult preventive services.

Administrative claims data are often used to assess the delivery of preventive services, yet there are important limitations. This study assessed the use of claims data to measure quality for pay-for-performance and as a preventive services screening tool compared with medical records review. Accuracy and bias in relying on claims data from a provider perspective were investigated, including a comparison of practice types. Claims data consistently underestimated the rate of preventive services, but the type of practice influenced accuracy. Claims data should be used cautiously, if at all, for pay for performance or to trigger reminders for preventive services completion.

The asthma ePrompt: a novel electronic solution for chronic disease management.

Objective. This study tested the ability of an electronic prompt to promote an asthma assessment during primary care visits. Methods. We performed a prospective study of all eligible adult patients with previously diagnosed asthma in three geographically distinct ambulatory family medicine clinics within a 4-month period. The usual clinic visit process was performed at two geographically distinct control sites (n = 75 and n = 55 patients, respectively). The intervention group site (n = 64) had an electronic flag embedded in the Patient Check-in Locator field which prompted the distribution of a self-administered Asthma Management Questionnaire (AMQ) in the waiting room. The primary outcome measure was a documented asthma severity assessment. Results. The front desk distributed the AMQ successfully in 100% of possible opportunities and the AMQ was completed by 84% of patients. Providers in the intervention group were significantly more likely than providers in the two non-intervention groups to document asthma severity in the medical record during a non-asthma ambulatory clinic visit (63.3% vs. 18.7% vs. 3.6%; p < .001). Conclusion. The provision of standardized asthma information triggered by an electronic prompt at the time of check-in effectively initiates an asthma assessment during the primary care visits.

Inclusion of short-term care patients affects the perceived performance of specialists: a retrospective cohort study

BackgroundCurrent publicly reported quality performance measures directly compare primary care to specialty care. Specialists see short-term patients referred due to poor control of their disease who then return to their local provider. Our study looked to determine if outcomes measured in short-term care patients differed from those in long-term care patients and what impact those differences may have on quality performance profiles for specialists.MethodsRetrospective cohort from a large academic medical Center. Performance was measured as “Optimal Care” - all or none attainment of goals. Patients with short-term care (<90 days contact) versus long-term care (>90 days contact) were evaluated for both specialty and primary care practices during the year 2008.ResultsPatients with short-term care had significantly lower “Optimal Care”: 7.2% vs. 19.7% for optimal diabetes care in endocrinology and 41.3% vs. 53.1% for optimal ischemic vascular disease care in cardiology (p < 0.001). Combining short and long term care patients lowered overall perceived performance for the specialty practice.ConclusionsFactors other than quality affect the perceived performance of the specialty practice. Extending current primary care quality measurement to short-term specialty care patients without adjustment produces misleading results.