Patterns of Benzodiazepines and Hypnotic Drugs Dispensing After Hip Fracture Among Older US Adults Previously on the Drugs.

Background: Benzodiazepines (BZD) and nonbenzodiazepine receptor agonist hypnotics (Z-drugs) strongly increase the risk for hip fractures and should be avoided among older adults with a fall or fracture history. We assessed BZD and Z-drugs refill patterns after discharge for hip fracture among older US adults and explored factors associated with refilling.

Methods: We conducted a retrospective cohort study of US Medicare fee-for-service beneficiaries (20% random sample) aged ≥ 66 years, hospitalized for hip fracture, and discharged home or to a skilled nursing facility.

Core Concepts in Pharmacoepidemiology: New-User Designs.

In this article, we review the history and key reasons for new-user comparisons in pharmacoepidemiology, highlighting the target trial framework as a unifying framework. We describe three distinct pharmacoepidemiological new-user study designs: (1) new-user versus non-user; (2) active comparator new-user; (i.e.

Validation of an international classification of disease, tenth revision, clinical modification (ICD-10-CM) algorithm in identifying severe hypoglycaemia events for real-world studies.

Aim: The transition to the ICD-10-CM coding system has reduced the utility of hypoglycaemia algorithms based on ICD-9-CM diagnosis codes in real-world studies of antidiabetic drugs. We mapped a validated ICD-9-CM hypoglycaemia algorithm to ICD-10-CM codes to create an ICD-10-CM hypoglycaemia algorithm and assessed its performance in identifying severe hypoglycaemia.

Materials And Methods: We assembled a cohort of Medicare patients with DM and linked electronic health record (EHR) data to the University of North Carolina Health System and identified candidate severe hypoglycaemia events from their Medicare claims using the ICD-10-CM hypoglycaemia algorithm.

Sound-Alike Look-Alike Confusion and Matching Medication Product Attributes: Simulated Case-Control Studies.

Sound-alike look-alike (SALA) medication confusions harm as many as 250 000 Americans annually. Most preventive strategies focus on medication name similarities. To evaluate the association between matching medication product attributes and SALA confusion.

A Query Workflow Design to Perform Automatable Distributed Regression Analysis in Large Distributed Data Networks.

Introduction: Patient privacy and data security concerns often limit the feasibility of pooling patient-level data from multiple sources for analysis. Distributed data networks (DDNs) that employ privacy-protecting analytical methods, such as distributed regression analysis (DRA), can mitigate these concerns. However, DRA is not routinely implemented in large DDNs.

Assessing the impact of the new ICD-10-CM coding system on pharmacoepidemiologic studies-An application to the known association between angiotensin-converting enzyme inhibitors and angioedema.

Purpose: To replicate the well-established association between angiotensin-converting enzyme inhibitors versus beta blockers and angioedema in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) era.

Methods: We conducted a retrospective, inception cohort study in a large insurance database formatted to the Sentinel Common Data Model. We defined study periods spanning the ICD-9-CM era only, ICD-10-CM era only, and ICD-9-CM and ICD-10-CM era and conducted simple-forward mapping (SFM), simple-backward mapping (SBM), and forward-backward mapping (FBM) referencing the General Equivalence Mappings to translate the outcome (angioedema) and covariates from ICD-9-CM to ICD-10-CM.

Early impact of the ICD-10-CM transition on selected health outcomes in 13 electronic health care databases in the United States.

Purpose: To describe the consistency in the frequency of 5 health outcomes across the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) eras in the US.

Methods: We examined the incidence of 3 acute conditions (acute myocardial infarction [AMI], angioedema, ischemic stroke) and the prevalence of 2 chronic conditions (diabetes, hypertension) during the final 5 years of the ICD-9-CM era (January 2010-September 2015) and the first 15 months of the ICD-10-CM era (October 2015-December 2016) in 13 electronic health care databases in the Sentinel System. For each health outcome reviewed during the ICD-10-CM era, we evaluated 4 definitions, including published algorithms derived from other countries, as well as simple-forward, simple-backward, and forward-backward mapping using the General Equivalence Mappings.

Medication-related clinical decision support alert overrides in inpatients.

Objective: To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons.

Materials And Methods: We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons.

Review of Nonformulary Medication Approvals in an Academic Medical Center.

Background: The Joint Commission requires hospitals to formally review formulary medications at least annually based on new clinical information. Although review of nonformulary medication (NFM) use is not required, frequent and inappropriate use of NFMs has the potential to increase hospital costs, negatively affect quality of care, and increase medication errors. Limited resources may restrict an institution's ability to review NFM use in addition to the required annual formulary review.

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.

Background: Experts suggest that formulary alerts at the time of medication order entry are the most effective form of clinical decision support to automate formulary management.

Objective: Our objectives were to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved.

Methods: Alert overrides of the top 11 (n = 206) most-utilized and highest-costing NFMs, from January 1 to December 31, 2012, were randomly selected for appropriateness evaluation.

A cross-sectional observational study of high override rates of drug allergy alerts in inpatient and outpatient settings, and opportunities for improvement.

Objectives: To evaluate how often and why providers overrode drug allergy alerts in both the inpatient and outpatient settings.

Design: A cross-sectional observational study of drug allergy alerts generated over a 3-year period between 1 January 2009 and 31 December 2011.

Setting: A 793-bed tertiary care teaching affiliate of Harvard Medical School and 36 primary care practices.

Development of an algorithm to assess appropriateness of overriding alerts for nonformulary medications in a computerized prescriber-order-entry system.

Purpose: An algorithm for assessing the appropriateness of physician overrides of clinical decision support alerts triggered by nonformulary medication (NFM) requests is described.

Methods: Data on a random sample of 5000 NFM alert overrides at Brigham and Women's Hospital over a four-year period (2009-12) were extracted from the hospital's computerized prescriber-order-entry (CPOE) system. Through an iterative process, a scheme for categorizing the reasons given by prescribers for alert overrides was developed.

Impact of incorporating pharmacy claims data into electronic medication reconciliation.

Purpose: The potential value of adding pharmacy claims data to the medication history in the electronic health record (EHR) to improve the accuracy of medication reconciliation was studied.

Methods: Three medication history sources were used for this evaluation: a gold-standard preadmission medication list (PAML) created by reviewing all available medication history information, an EHR-generated PAML, and pharmacy claims data. The study population consisted of patients from the Partners Medication Reconciliation Study with medication history information available from all three medication history sources.

Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.

Objective: Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior.

Methods: We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013.