Understanding and Interpreting Adverse Drug Event (ADE) Readmission Reports

Transcription

1 Understanding and Interpreting Adverse Drug Event (ADE) Readmission Reports Lindsay Holland Director, Care Transitions Health Services Advisory Group (HSAG) October 24, 2017

2 Today s Webinar Objectives Review the Medicare Fee-for-Service (FFS) ADE data report. Discover how to use the report to identify patients on high-risk medications who are at higher risk for readmission. Describe and demonstrate how to use the ADE report in your facility. 2

3 HSAG: Your Partner in Healthcare Quality HSAG is California s Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO). QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS). The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level. 3

4 Overview HSAG is contracted by CMS to work with healthcare providers to: Improve coordination of care Reduce hospital readmissions Improve medication safety for ADEs for patients in the community 4

5 Readmissions and Medication Safety HSAG works with hospitals to reduce ADEs ADEs contribute to readmissions and are the leading cause of preventable patient harm. 1 High-priority medication targets for the National Action Plan for Adverse Drug Event Prevention 2 (common, preventable, and measurable ADEs): Anticoagulants Diabetic agents Opioids 5 1. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9): U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). National Action Plan for Adverse Drug Event Prevention. Washington, DC: Author.

6 Emergency Department (ED) Visits for ADEs Associated with anticoagulants 17.6% of the visits, with 48.8% of cases resulting in hospitalization. Associated with diabetic agents 13.3% of the visits, with 38.5% resulting in hospitalization. Associated with opioids 6.8% of the visits, with 24.6% resulting in hospitalization. 6 Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US Emergency Department Visits for Outpatient Adverse Drug Events, JAMA. 2016;316(20): doi: /jama

7 30-Day Readmissions Among Medicare FFS Beneficiaries on HRMs in California Q Q Day All-Cause Readmission Rate 18.4% 30-Day HRM Readmission Rate 21.6% Readmissions among beneficiaries on HRMs are much more frequent than the general population, suggesting ample opportunity for improvement. Percent of 30-day readmissions with an anticoagulant or diabetes agent ADE are much higher than the percent of readmits with an opioid ADE. 7 Data files provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS) were used for analysis in this report. The data files include Part-A and Par-D claims for Medicare Fee-for-Service beneficiaries.

8 Adverse Drug Event Facility Report For Your Community Hospital Q Q1 2017

9 High-Risk Medication (HRM) Categories Data sources are Medicare Fee for Service (FFS) Part-A and Part-D claims. Beneficiaries are considered on a HRM if they have more than 30 days of HRM coverage (opioids, anticoagulants, or diabetic agents) during the time period of interest. Beneficiaries may qualify as being on a HRM for more than one drug class. Adverse Drug Events (ADEs) are evaluated in both the inpatient (IP) and emergency department (ED) setting based on the beneficiary s HRM drug classification. If a beneficiary is on an opioid, and has a claim identified as an ADE related to opioids, this is counted in the numerator. If a beneficiary is on an opioid, and has a claim identified as an ADE related to anticoagulants, this is not counted in the numerator. Missing data points or figures indicate there were no applicable data for your hospital during the specified time period. 9

10 ADE Rates Q Q Note: Overall will not be equal to the total of the individual drug categories as some beneficiaries are considered high risk for more than one sub population. 10

11 Anticoagulant ADEs by Diagnosis Code 1 Q Q ICD-9 Description Count ICD-10 Description Count Diagnosis Diagnosis Code Code Abnormal coagulation profile 25 E9342 Anticoagulants causing adverse effect in therapeutic use Epistaxis Hematuria, unspecified Hemorrhage of gastrointestinal tract, unspecified Blood in stool Hemorrhage of rectum and anus Hemoptysis, unspecified 4 R791 Abnormal coagulation profile 36 T45515A Adverse effect of anticoagulants, initial encounter 16 K922 Gastrointestinal hemorrhage, unspecified 16 R319 Hematuria, unspecified 13 R040 Epistaxis 10 K625 Hemorrhage of anus and rectum 9 K2971 Gastritis, unspecified, with bleeding 4 R042 Hemoptysis Angiodysplasia of stomach and duodenum with hemorrhage 3 T45511A Poisoning by anticoagulants, accidental (unintentional), initial encounter Unspecified gastritis and gastroduodenitis with hemorrhage 2 R310 Gross hematuria 3 1 Only the top 10 diagnosis codes are shown. 11

12 Diabetic Agent ADEs by Diagnosis Code 2 Q Q ICD-9 Diagnosis Code Description Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled Diabetes with other specified manifestations, type II or unspecified type, uncontrolled E9323 Insulins and antidiabetic agents causing adverse effect in therapeutic use Count 2512 Hypoglycemia, unspecified Poisoning by insulins and antidiabetic agents Other abnormal glucose Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled ICD-10 Diagnosis Code Description Count E11649 Type 2 diabetes mellitus with hypoglycemia without coma 51 E1169 Type 2 diabetes mellitus with other specified complication 17 E162 Hypoglycemia, unspecified 8 E10649 Type 1 diabetes mellitus with hypoglycemia without coma 6 T383X5A E1369 T383X1A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter Other specified diabetes mellitus with other specified complication Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional), initial encounter E1069 Type 1 diabetes mellitus with other specified complication Only the top 10 diagnosis codes are shown. 12

13 Opioid ADEs by Diagnosis Code 3,4 Q Q ICD-9 Description Count ICD-10 Description Count Diagnosis Diagnosis Code Code E9352 Other opiates and related narcotics causing adverse effect in therapeutic use 6 T40601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter 10 E8502 Accidental poisoning by other opiates and related narcotics Poisoning by opiates and related narcotics, other Poisoning by opium (alkaloids), unspecified Altered mental status Drug-induced delirium Other alteration of consciousness Other dyspnea and respiratory abnormalities 1 E9500 Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics 486 Pneumonia, organism unspecified F1123 Opioid dependence with withdrawal 4 R4182 Altered mental status, unspecified 4 T402X1A Poisoning by other opioids, accidental (unintentional), initial encounter T40605A Adverse effect of unspecified narcotics, initial encounter 3 T403X1A Poisoning by methadone, accidental (unintentional), initial encounter T402X5A Adverse effect of other opioids, initial encounter 2 F11921 Opioid use, unspecified with intoxication delirium 1 T402X2A T404X1A Poisoning by other opioids, intentional self-harm, initial encounter Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter Only the top 10 diagnosis codes are shown. 4 Some opioid ADEs require two diagnosis codes used in combination. 13

14 Readmission Rates for HRM Beneficiaries 14

15 Readmissions for HRM Beneficiaries on an Anticoagulant 15

16 Readmissions for HRM Beneficiaries on a Diabetic Agent 16

17 Readmissions for HRM Beneficiaries on an Opioid 17

18 Readmissions by Drug Category 18

19 Overall ED Utilization Within 30 Days of Discharge from an IP Visit 19

20 Overall ED Utilization Within 30 Days of Discharge from an IP Visit for HRM Beneficiaries on an Anticoagulant 20

21 Overall ED Utilization Within 30 Days of Discharge from an IP Visit for HRM Beneficiaries on a Diabetic Agent 21

22 Overall ED Utilization within 30 Days of Discharge from an IP Visit for HRM Beneficiaries on an Opioid 22

23 General Utilization by HRM Beneficiaries 23

24 General Utilization by HRM Beneficiaries on an Anticoagulant 24

25 General Utilization by HRM Beneficiaries on a Diabetic Agent 25

26 General Utilization by HRM Beneficiaries on an Opioid 26

27 Anticoagulant ADEs by Prescription Q Q Drug Class Number of ADEs Warfarin 120 Direct Factor Xa Inhibitors (New Oral Anticoagulants) 56 Direct Thrombin Inhibitors 7 Heparins and Heparinoid-Like Agents 3 27

28 Diabetic Agent ADEs by Prescription Q Q Drug Class Number of ADEs Insulin 106 Sulfonylureas 47 Dipeptidyl Peptidase-4 (DPP-4) Inhibitors 12 Thiazolidinediones 8 Antidiabetic Combination Agents 3 Meglitinides 3 Glucagon-Like Polypeptide-1 (GLP-1) Receptor Agonists Sodium-Glucose Co-Transporter (SGLT) Inhibitors 2 1 Alpha-Glucosidase Inhibitors 1 28

29 Opioid ADEs by Prescription Q Q Drug Class Number of ADEs Hydrocodone Combinations 18 Morphine 7 Codeine and Codeine Combinations 5 Oxycodone 5 Methadone 3 Fentanyl 3 Hydromorphone 2 Buprenorphine 1 Oxymorphone 1 29

30 Thank you! Lindsay Holland Director, Care Transitions HSAG

31 CMS Disclaimer This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-C