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Effect of Beers Criteria on Healthcare Utilization and Cost in Community-Dwelling Elderly Patients

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Effect of Beers Criteria on Healthcare Utilization and Cost in Community-Dwelling Elderly Patients Medical University of South Carolina MEDICA MUSC Theses and Dissertations 2018 Effect of Beers Criteria on Healthcare Utilization and Cost in Community-Dwelling Elderly Patients Courtney O'Neill Roldan Medical University of South Carolina Follow this and additional works at: https://medica-musc.researchcommons.org/theses Recommended Citation Roldan, Courtney O'Neill, "Effect of Beers Criteria on Healthcare Utilization and Cost in Community- Dwelling Elderly Patients" (2018). MUSC Theses and Dissertations. 294. https://medica-musc.researchcommons.org/theses/294 This Dissertation is brought to you for free and open access by MEDICA. It has been accepted for inclusion in MUSC Theses and Dissertations by an authorized administrator of MEDICA. For more information, please contact [email protected]. EFFECT OF BEERS CRITERIA ON HEALTHCARE UTILIZATION AND COST IN COMMUNITY-DWELLING ELDERLY PATIENTS by Courtney O’Neill Roldan, MHA A dissertation submitted to the faculty of the Medical University of South Carolina in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Health Professions © Courtney O’Neill Roldan 2018 All Rights Reserved Acknowledgments I would like to acknowledge my dissertation committee chair Dr. Kit Simpson, and committee members Dr. Annie Simpson, Dr. William Moran, and Dr. David Taber for their guidance throughout this study. Without their unending service and expertise this project would not have been successful. Not only did Dr. Kit Simpson provide the data for this study, but she also introduced me to Beers Criteria many months before this project came to fruition. I am especially grateful for Dr. Kit Simpson’s mentorship that enabled me to preserve through this project, Dr. Annie Simpson’s encouragement and sympathetic approach that helped me overcome the challenging hurdles of the dissertation process, and Dr. Moran and Dr. Taber’s medical experience and insightful feedback regarding the scientific and clinical implications of this study. I owe many thanks to my professional mentor, Dr. Jacobo Mintzer, who not only supported my doctoral endeavors over the course of this program, but was a motivating force so many years ago to pursue this path. Dr. Mintzer not only introduced me to the research field, but he has provided me many opportunities over the years, including my doctoral degree, that I am so grateful for and know would not have been possible without his mentorship. I would also like to thank my professional colleagues for their support over the years as I successfully completed each stage of the program and especially this dissertation project. A special thank you goes to Dr. Emily Johnson for her support and encouragement over the years. Her advice began before I was accepted into the doctoral program, and that guidance was steadfast over many years through the final stretch of my dissertation. I am also grateful for the emotional support offered by my fellow classmates and will always cherish the bonds we developed through our doctoral endeavors. Lastly, I would not have achieved this momentous accomplishment without the unwavering love and support of my husband, parents, and family. They remained by my side at each stage of the doctoral program and reminded me that each sacrifice over the years was for a greater purpose. They were my cheerleaders to the very end of my dissertation, and I am forever grateful for the opportunity to share this accomplishment with them. iii Abstract of Dissertation Presented to the Doctor of Philosophy Program in Health and Rehabilitation Science Medical University of South Carolina In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy EFFECT OF BEERS CRITERIA ON HEALTHCARE UTILIZATION AND COST IN COMMUNITY-DWELLING ELDERLY PATIENTS by Courtney O’Neill Roldan, MHA Chairperson: Kit N. Simpson, DrPH Committee: Annie N. Simpson, PhD William P. Moran, MD, MS David J. Taber, PharmD, BCPS This retrospective cohort study uses 2013 Marketscan® claims data to quantify healthcare resource utilization and national healthcare costs attributable to using potentially inappropriate medications represented in 2012 Beers Criteria. We compare hospital admissions, days spent in the hospital, and total healthcare costs generated from inpatient and outpatient visits and prescription medication use for community-dwelling Medicare patients that received medications in Beers Criteria compared to a well-matched group of patients that received medications not included in Beers Criteria. Using Beers Criteria medications is associated with greater odds of hospital admission. Of those that are hospitalized, patients using Beers Criteria medications experience a greater number of hospital admissions and spend more days in the hospital compared to patients treated with medications not in Beers Criteria. We found total inpatient, outpatient, and prescription drug costs to be higher on average for patients that received Beers Criteria medications, and these patients were responsible for significantly higher annual healthcare costs in 2013. This study suggests the importance reducing the risk of unnecessary hospitalizations attributed to using inappropriate medications to minimize the burden the elderly population will have on our national healthcare system in the future. iv TABLE OF CONTENTS Acknowledgments........................................................................................................................... iii Abstract ........................................................................................................................................... iv List of Figures ............................................................................................................................... viii List of Tables .................................................................................................................................. ix Abbreviations ................................................................................................................................... x I. INTRODUCTION ................................................................................................................... 1 II. REVIEW OF THE LITERATURE .......................................................................................... 7 2.1 Polypharmacy ................................................................................................................ 10 2.2 Medication Evaluation Tools ......................................................................................... 14 2.2.1 Medication Appropriateness Index ................................................................ 15 2.2.2 Improved Prescribing in the Elderly Tool ...................................................... 17 2.2.3 STOPP and START Criteria .......................................................................... 19 2.3 History of Beers Criteria ................................................................................................ 24 2.4 Medication Classes Included in Beers Criteria .............................................................. 26 2.5 Limitations of Beers Criteria ......................................................................................... 35 2.6 Using Beers Criteria to Describe the Prevalence of PIM Use ....................................... 38 2.6.1 Prevalence of PIMs Using Beers Criteria (U.S. studies) ............................... 38 2.6.2 Prevalence of PIMs Using Beers Criteria (Non-U.S. studies) ....................... 44 2.6.3 Prevalence of PIMs Using Beers Criteria and other evaluation tools (U.S. studies) .......................................................................................................... 49 2.6.4 Prevalence of PIMs Using Beers Criteria and other evaluation tools (Non- U.S. studies) .................................................................................................. 52 2.7 Using Beers Criteria to Measure Health Outcomes ....................................................... 55 2.7.1 Hospitalizations, ED Visits, & Institutionalization ........................................ 56 2.7.2 ADEs .............................................................................................................. 59 2.7.3 Quality of Life ................................................................................................ 61 2.8 Using Beers Criteria in Technology-Based Studies ....................................................... 63 2.9 Using Beers Criteria to Quantify Impact of PIM Use on Healthcare Costs ................... 67 2.10 Propensity Score Matching ............................................................................................ 69 2.10.1 Beers Criteria Research using Propensity Score Matching ................................ 72 2.11 Summary ........................................................................................................................ 74 v III. METHODOLOGICAL BACKGROUND ............................................................................. 77 3.1 Study Design .................................................................................................................. 79 3.2 Study Population ............................................................................................................ 86 3.2.1 Medicare Coverage in the Elderly.................................................................. 87 3.3 Administrative Claims Data ..........................................................................................
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