Magazine article Drug Topics

Keeping Patients out of the Hospital: ProVantage's Goal

Magazine article Drug Topics

Keeping Patients out of the Hospital: ProVantage's Goal

Article excerpt

An alarming study from the Institute of Medicine carries the unwelcome news that thousands of patients die every year from prescription drug errors. The report gives no breakout of fatalities resulting from inhospital drugs versus those administered in the community, but outpatient drugs must bear a heavy share of the blame. So said Peter F. Hoffman, M.D., senior vp.chief medical officer, ProVantage Health Services, Waukesha, Wis. The price ticket for outpatient drug errors that result in patient hospitalization is estimated at $40 billion to $50 billion a year.

With the U.S. health-care bill running about $1 trillion, drug-induced hospitalizations are therefore responsible for 4% to 5% of the total tab.

The drug reactions triggering this heavy human and financial load are, according to Hoffman, those in which the drug worsens the patient's disease; those causing a toxic effect when taken with another drug; and those that prompt another medication to become subtherapeutic.

"Wouldn't it be helpful," asked Hoffman, "if one could identify patients at risk of drug-induced hospitalizations and intervene to prevent those hospitalizations?"

That, in fact, is what ProVantage aims to do. Its Health Benefit Management division, which covers pharmacy and vision benefit management, begins by collecting data gleaned from claims for outpatient pharmaceuticals and medical visits, plus hospital discharge data. All three sectors are then integrated, giving the company drug-disease data on Medicaid patients as well as those covered by private indemnity plans.

The next step is to analyze the integrated data, using the company's RationalMed software. The analysis depends on a "rules engine" using 7,800 clinically based drug utilization rules, taking into account drug duplication, overuse or underuse, drug-drug interactions, and so on.

Patients identified as having rules violations are then screened for other, individual risk factors. As Hoffman explained, an older person is more at risk than a younger one, females at higher risk than males, patients seeing six doctors more at risk than those under the care of one or two physicians, and patients with five diagnoses at greater risk than those with fewer diagnoses.

Using rules violations and individual risk data, ProVantage's computers assign each patient a risk score. …

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