Administrative claims data to support pragmatic clinical trial outcome ascertainment on cardiovascular health

Abstract

Background/aims Health plan administrative claims data present a cost-effective complement to traditional trial-specific ascertainment of clinical events typically conducted through patient report or a single health system electronic health record. We aim to demonstrate the value of health plan claims data in improving the capture of endpoints in longitudinal pragmatic clinical trials. Methods This retrospective cohort study paralleled the design of the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial designed to compare the effectiveness of two doses of aspirin. We applied the ADAPTABLE identification query in claims data from Anthem, an American health insurance company, and identified health plan members who met the ADAPTABLE trial criteria. Among the ADAPTABLE eligible members, we selected overlapping members with PCORnet Clinical Data Research Networks in the 2 years prior to the index date (1 April 2014). PCORnet Clinical Data Research Networks consist of network partners (or healthcare systems) that store their electronic health record data in the same format to support multi-institutional research. ADAPTABLE outcome events—cardiovascular hospitalizations including admissions for myocardial infarction, stroke, or cardiac procedures; hospitalizations for major bleeding; and in-hospital deaths—were evaluated for a 2-year follow-up period. Events were classified as within or outside PCORnet Clinical Data Research Networks using facility identifiers affiliated with each hospital stay. Patient characteristics were examined with descriptive statistics, and incidence rates were reported for available Clinical Data Research Networks and claims data. Results Among 884,311 ADAPTABLE eligible health plan members, 11,101 patients overlapped with PCORnet Clinical Data Research Networks. Average age was 70 years, 71% were male, and average follow-up was 20.7 months. Patients had 1521 cardiovascular hospitalizations (571 (37.5%) occurred outside PCORnet Clinical Data Research Networks), 710 for major bleeding (296 (41.7%) outside PCORnet Clinical Data Research Networks), and 196 in-hospital deaths (67 (34.2%) outside PCORnet Clinical Data Research Networks). Incidence rates (events per1000 patient-months) differed between available network partners and claims data: cardiovascular hospitalizations, 4.1 (95% confidence interval: 3.9, 4.4) versus 6.6 (95% confidence interval: 6.3, 7.0), major bleeding, 1.8 (95% confidence interval: 1.6, 2.0) versus 3.1 (95% confidence interval: 2.9, 3.3), and in-hospital death, 0.56 (95% confidence interval: 0.47, 0.67) versus 0.85 (95% confidence interval: 0.74, 0.98), respectively. Conclusion This study demonstrated the value of supplementing longitudinal site-based clinical studies with administrative claims data. Our results suggest that claims data together with network partner electronic health record data constitute an effective vehicle to capture patient outcomes since >30% of patients have non-fatal and fatal events outside of enrolling sites.

Characterization of bariatric surgery and outcomes using administrative claims data in the research network of a nationwide commercial health plan

“…The value of claims data was demonstrated in our earlier PCORnet prospective longitudinal pragmatic study: Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE) trial designed to compare the effectiveness of two doses of aspirin. Applying the design of the ADAPTABLE trial in HCARN claims data, we found that claims data captured > 30% non-fatal and fatal hospital events in cardiovascular health occurring in health systems outside of a potential enrolling CRN health system [27]. Expansion of this approach could substantially increase the availability of information for clinical comparative effectiveness research.…”

Rationale and Design of the Aspirin Dosing—A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE) Trial

“…The accuracy of the coding algorithms used to identify MI, stroke, and bleeding have been previously validated . Furthermore, linkages are performed with Medicare and PCORnet partner health plan administrative claims databases to identify and confirm potential end points not captured in the local health system EHR data warehouses (termed out-of-network events ) using the same programming algorithms . Inpatient deaths are captured through these approaches, but out-of-hospital deaths are confirmed with queries to the Medicare data and/or via notification by family or friends of the participant.…”

PCORnet® 2020: current state, accomplishments, and future directions

“…A strength of the health plan data is the ability to collect information from across health systems both within medical institutions within Network Partners and beyond. Overall, patients are observed for 2.63 years with a range by age group of 1.92 (18e24 years old) to 3.59 (65þ years old), providing for complete person-time ascertainment for observational research, which supports cross-sectional and longitudinal study designs and pragmatic capture of clinical outcomes for trials such as ADAPTABLE [19]. Health plan data can also be utilized to recruit members into pragmatic clinical trials [20].…”