medication regimen complexity in home health care
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Medication Regimen Complexity in Home Health Care. June 10, 2010 CTA site visit. Why should regimen complexity matter?. Number of medications, dosage frequency, administration, instructions & prescribed dose all have been linked individually to: Medication adherence Adverse drug events - PowerPoint PPT PresentationTRANSCRIPT
Medication Regimen Complexity in Home Health
Care
June 10, 2010CTA site visit
2
Why should regimen complexity matter? Number of medications, dosage frequency,
administration, instructions & prescribed dose all have been linked individually to: Medication adherence Adverse drug events
Nurses typically use the number of medications as an approximation of complexity
The “whole may be greater than the sum of the parts” – complexity may have an “additive” effect on patient outcomes
3
VNSNY Analysis: Research Questions
1. Does the MRCI add to what we already know?
Is it any different from the count of medications?
2. Is the MRCI related to patient outcomes?
Emergency Department use Hospitalizations
4
Analysis: Population Studied
All new admissions to VNSNY’s Adult Acute Care program in 2008 Does not include patient episodes in
Lombardi or Congregate programs Includes all payersAt least one medication at admission
Median = 7 medicationsMedication regimen at admissionTotal patient episodes (N) studied =
89,645
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Distribution of MRCI at VNSNY
Source: 89,645 new admissions to ADU in 2008. MRCI calculated as of admission entry date.
Scores range from 1.5 to 88.5Median score is 14.5
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MRCI vs. Count of Medications
MRCI scores are correlated to medication count, as expected
At any given number of medications, MRCI scores vary widely For example, among patients on 7
medications MRCI scores range from 6.5 to 42.0
Average MRCI score is about 15.0
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MRCI Ranges Widely at any Given Med Count
MRCI is related to medication count, but is not the same
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Analysis: MRCI and Emergency Dept UseMRCI Decile % with ED visit
1 11.13
2 11.21
3 12.85
… …
8 18.42
9 22.19
10 25.54
Patients with higher MRCI scores are at greater risk for ED use
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Analysis: MRCI and 60-day Hospitalization
MRCI Decile % with Hospitalization
1 12.72
2 13.34
3 15.24… …
8 21.91
9 25.00
10 28.82Patients with higher MRCI scores are at greater risk for hospitalization
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Analysis: Does MRCI Predict Hospitalization?
Dependent variable is count of OBQI hospitalizations within 60 days of admission to VNSNY
Compare how MRCI performs vs. medication count Event count modeled using poisson regression
controlling for patient case-mix
Expected count of OBQI
hospitalizations within 60 days of
admission
=
MRCI, medication count, and other
patient characteristics at
start of care
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Hospitalization Model Case-mix Adjustment
Constructed a priori based on prior work Case-mix at start of care includes:
Integumentary status Diagnosis of chronic disease
Diabetes, CHF, COPD, CVA, PVD, AMI, cancer, arrhythmia, hepatic / renal disease, HTN, Alzheimer’s, organic brain disease, HIV, osteoarthritis, dementia
Admission from inpatient hospital stay
Presence of anti-coagulant in regimen
Demographics (age, sex, region)
Functional status (ADL/IADL dependencies)
Clinical status Dyspnea, intravenous or
oxygen therapy, sensory status, pain, cognitive status, depression
Elimination status
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Results: MRCI Predicts Hospitalizations
ModelCount
IRRp
MRCI IRR
p
Count of Medications only (Model 1) 1.0540.00
MRCI only (Model 2) 1.024 0.00
Both Count of Medications and MRCI (Model 3)
1.0190.0
81.018 0.00
Test 2 d.f. p value
Likelihood Ratio Test (Model 1 nested in Model 3)
55.64 2 0.00
Both MRCI score and medication count are highly significant predictors of OBQI hospitalizations within 60 days of home health admission Models are fully case-mix adjusted MRCI is a significant predictor after controlling for medication count MRCI is more strongly predictive of hospitalizations than medication count
Together, MRCI & medication count are better predictors of hospitalizations than either one alone
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Predicted Effect of Changing MRCI Score
Modest reduction in medication complexity has the potential to lower the number of hospitalizations
experienced by home health patients
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Summary of Analyses
Medication Regimen Complexity can be measured by adapting the MRCI for a home care population
MRCI score is related to, but not the same as, medication count
Higher regimen complexity is related to higher risk of hospitalizations
Reduction of regimen complexity, holding medication count constant, has the potential to reduce hospitalization events