Журнал фармацевтической помощи и систем здравоохранения
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Using Clinically-Enhanced Claims Data to Discern Current Patterns of Inpatient Care and Identify Opportunities for Improvement

Michael Pine, Donald E Fry, Linda Hyde, Kay Whitman, David Locke, Agnes Reband, James M Naessens, Joseph Schindler, Jaclyn Roland and Mark Sonneborn

Background: The rapid evolution of electronic medical records presents an opportunity to integrate laboratory and pharmacy order data with administrative claims data to yield an enhanced database. This enhanced database would relate drug administration to admission diagnostic information and changes in laboratory test results.
Methods: Administrative claims for 2010-2012 from 16 Minnesota hospitals were enhanced by the electronic pharmacy order and laboratory data. A total of 539 patients admitted for congestive heart failure were grouped by admission creatinine, blood urea nitrogen, and brain natriuretic peptide levels. Descriptive equations were derived relating admission laboratory profiles to two-day administration of furosemide and to corresponding drug administration to 361 patients with good therapeutic responses.
Results: Statistically-significant, clinically-plausible relationships between furosemide administration, admission laboratory test results, and therapeutic responses were established. Patients with high admission creatinine levels but lower than threshold BUN-to-creatinine and BNP levels often were receiving suboptimal two-day doses of furosemide.
Conclusions: High-quality hospital claims databases enhanced with laboratory and pharmacy order data can be used to characterize current inpatient drug therapy and guide efforts to improve clinical effectiveness.