applying diagnosis and pharmacy-based risk models to predict pharmacy use in aragon, spain the impact of a local calibration应用诊断和pharmacy-based风险模型预测药房在阿拉贡,西班牙当地校准的影响.pdfVIP

Calderón-Larrañaga et al. BMC Health Services Research 2010, 10:22 /1472-6963/10/22 RESEARCH ARTICLE Open Access Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon, Spain: The impact of a local calibration 1* 2 1 2 1 Amaia Calderón-Larrañaga , Chad Abrams , Beatriz Poblador-Plou , Jonathan P Weiner , Alexandra Prados-Torres Abstract Background: In the financing of a national health system, where pharmaceutical spending is one of the main cost containment targets, predicting pharmacy costs for individuals and populations is essential for budget planning and care management. Although most efforts have focused on risk adjustment applying diagnostic data, the reliability of this information source has been questioned in the primary care setting. We sought to assess the usefulness of incorporating pharmacy data into claims-based predictive models (PMs). Developed primarily for the U.S. health care setting, a secondary objective was to evaluate the benefit of a local calibration in order to adapt the PMs to the Spanish health care system. Methods: The population was drawn from patients within the primary care setting of Aragon, Spain (n = 84,152). Diagnostic, medication and prior cost data were used to develop PMs based on the Johns Hopkins ACG methodology. Model performance was assessed through r-squared statistics and predictive ratios. The capacity to identify future high-cost patients was examined through c-statistic, sensitivity and specificity parameters. Results: The PMs based on pharmacy data had a higher capacity to predict future pharmacy expenses and to identify potential high-cost patients than the models based on diagnostic data alone and a cap