Risk Adjustment Using Automated Ambulatory Pharmacy Data

Abstract

HCCs produce more accurate forecasts of total cost, but the pharmacy-based RxRisk is an alternative risk assessment instrument to several diagnostic based models and depending on the nature of the application may be a more appropriate option for medical risk analysis.

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

“…These analyses also allowed us to identify the proportion of the KPCO pediatric population (age <5 years) who were nonusers of WCC. Colorado-specific data from the National Survey for Children with Special Health Care Needs 13 along with a validated pharmacybased risk adjustment system, called RxRisk, [14][15][16][17] were used to assign the proportion of pediatric members by age category that were likely to have been "high risk" in 2006.…”

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

“…Covariates obtained from the survey included sociodemographic characteristics (e.g., age, sex, race, educational level, marital status and perceived social support), diabetes characteristics (duration of diabetes, initial treatment prescribed, and type of current treatment), as well as questions regarding height and weight (used to compute BMI), smoking status, and physical activity from the Summary of Diabetes Self-Care Questionnaire. 25 Covariates obtained from medical record and pharmacy data review included baseline non-diabetes medical comorbidity measured with the RxRisk, an automated pharmacy-based data model that incorporates 46 medical conditions (e.g., cardiovascular disease, asthma, cancer) and has been validated as an independent predictor of increased healthcare costs; 26 the International Classification of Disease Ninth Revision (ICD-9) diagnostic codes for chronic obstructive pulmonary disease (COPD) (which is not included in the RxRisk); number of diabetes complications based on ICD-9 diagnostic codes and laboratory data; 27 the Hb A1c level closest to the baseline survey date; use of oral hypoglycemic agents and/or insulin; one or more hospitalizations in the 2 years prior to study enrollment, and any ICD-9 diagnostic code for alcohol abuse or dependence made in the 2 years prior to study enrollment.…”

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

“…26 Other nondiabetes-related medical comorbidity was ascertained by using the RxRisk score, a computerized pharmacy measure of medical comorbidity, which is associated with costs and utilization. 27 Hypertension diagnosis at baseline was determined by review of paper and electronic medical records. The HbA 1c level drawn closest to baseline enrollment was obtained from automated clinical laboratory databases.…”