EPIMED: Can DRGs help to improve effectiveness, efficiency and safe use of drugs?

Size: px

Start display at page:

Download "EPIMED: Can DRGs help to improve effectiveness, efficiency and safe use of drugs?"

Daisy Baker
6 years ago
Views:

1 EPIMED: Can DRGs help to improve effectiveness, efficiency and safe use of drugs?

2 Innovation and Information Technologies to improve Health Care Management

3 Background High health care costs (growing) Pharmacological and diagnostic innovation More expensive and sophisticated treatments Personalized medicine Rare diseases Life-threatening diseases becoming chronic Increased life expectancy Patient s rights Economic crisis

4 The challenge Sustainability of the Health System Doing more with less Rationalisation rather than rationing (effectiveness, efficiency and safety) Not only contingency actions but also implementing structural changes Change to grow and to preserve the essential

5 Factors influencing drug costs Purchase price Storage Distribution Inappropriate use of drugs Key concepts Rationalize rather than rationing Networking Prescription management

6 How can we be sure that drugs are used effectively, efficiently and safely? Guideline adherence? Clinical variability? Sequential therapy? Safety problems?

7 How can we identify improvement opportunities? Drug use studies (qualitative and quantitative) Benchmarking How can we estimate the potential benefit of measures we are planning to implement to prioritize them? How can we evaluate the impact of implemented measures?

8 The EPIMED STUDY

9 Drug use studies Patient database Drug use database IR-DRG grouper Qualitative and quantitative drug use evaluation reports 1. Pooled hospital database 2. Single hospital database

10 EPIMED network HOSPITAL GENERAL UNIVERSITARIO GREGORIO MARAÑÓN HOSPITAL DE MÓSTOLES HOSPITAL GENERAL UNIVERSITARI D'ELCHE HOSPITAL UNIVERSITARI SANT JOAN D'ALACANT HOSPITAL CAN MISSES HOSPITAL CLÍNIC I PROVINCIAL DE BARCELONA HOSPITAL DE LA SANTA CREU I SANT PAU HOSPITAL UNIVERSITARI GERMANS TRIAS I PUJOL HOSPITAL UNIVERSITARI DE BELLVITGE HOSPITAL UNIVERSITARI VALL D'HEBRON HOSPITAL DE IGUALADA HOSPITAL UNIVERSITARI DE GIRONA DR. JOSEP TRUETA HOSPITAL UNIVERSITARI ARNAU DE VILANOVA HOSPITAL CLÍNICO UNIVERSITARIO DE VALENCIA COMPLEJO HOSPITALARIO LA MANCHA CENTRO HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA HOSPITAL SAN AGUSTÍN (AVILÉS) HOSPITAL DE CRUCES HOSPITAL DE TERRASSA HOSPITAL RAMÓN Y CAJAL COMPLEJO UNIVERSITARIO DE SAN CARLOS COMPLEJO HOSPITALARIO VIRGEN DEL ROCÍO COMPLEJO ASISTENCIAL DE SALAMANCA HOSPITAL DE SANT BERNABÉ HOSPITAL DE VALME HOSPITAL VIRGEN DE LAS NIEVES HOSPITAL TORRECÁRDENAS HOSPITAL COSTA DEL SOL (MARBELLA) HOSPITAL DE GALDAKAO HOSPITAL MIGUEL SERVET HOSPITAL DE VALLADOLID CENTRO HOSPITALARIO DE MANRESA HOSPITAL DE NAVARRA HOSPITAL UNIVERSITARI LA FE HOSPITAL DE GETAFE HOSPITAL DEL MAR

11 Why IR-DRGs? AP DRG IR DRG Only conventional Hospitalization Conventional Hospitalization and also ambulatory processes (Dayhospital, Ambulatory Surgery, etc) No severity of illness levels Every DRG categorized by three levels of severity Allows International Comparison

12 EPIMED Records Patients EPIMED IR-DRG

data Drug use database Drug use database Encrypted Web access to reports Safe

13 How can hospitals participate? Patient database Patient database Encrypted Hospital Anonymous and encrypted data Drug use database Drug use database Encrypted Web access to reports Safe shipping IR-DRG Encrypted Patient database Encrypted Data processing Drug use database Encrypted Drug use database Encrypted

14 (password needed) Hospital A Web access to reports Results Hospital A Standard Results Hospital B Results Hospital B

15 The tool

16 Drill and down system Chronic Obstructive Pulmonary Disease

17 Benchmarking

18 Benchmarking

19 How can the EPIMED system help participants?

20 Key Processes "!!

21 EPIMED as a tool for pharmacy deferred intervention

22 Ranking IR-GRD

23 Ranking IR-GRD (variation vs the year before)

24 Starting search from a specific drug: Posaconazole Antifungal prophylaxis of filament fungi in highly immunodepressed patients Process variation % 17S Haematology Medical ,08% 17P Oncology Medical /0 1ANR Anaesthesia i Reanimation 5a Medical /0 11P Emergency Support MI /0 1URG Emergency Department Medical / Nephrology Hospital Surgical ,71% IR-DRG Cost Patients Cost/Patient BONE MARROW TRANSPLANTATION 22, , ACUTE LEUKEMIA 18, , OTHER GASTROENTERITIS & ABDOMINAL PAIN 3, , OTHER DIGESTIVE SYSTEM DIAGNOSES 3, , COAGULATION DISORDERS 3, ,271.25

25 Starting search from a specific DRG: Cardiac and/or Pulmonary transplantation

26 Appendicitis: Antibiotic Treatment 70,8% Cost Patients Piperacillin / tazobactam 4.154,38 18,6% 54 14,8% Cefoxitin 3.162,00 14,1% 91 25,0% Amoxicillin / clavulanic acid 2.428,20 10,9% ,0% Ertapenem 2.333,97 10,4% 9 2,5% Cilastatin/Imipenem 1.965,79 8,8% 8 2,2% Meropenem 1.611,80 7,2% 11 3,0% Azithromycin 280,33 1,3% 3 0,8% Ciprofloxacin 136,60 0,6% 32 8,8% TOTAL ,

27 Ertapenem Use None of the 9 patients treated with ertapenem presented infection caused by ESBL producing bacteria. Median duration of therapy with ertapenem was 4,82 days. Amoxicillin/Clavulanate Treatment Cost: 0,83 x 3 x 4,82 x 9 = 108,02 Savings: 108, ,97 = ,95 (10% cost reduction /appendicitis episode) ESBL = Extended-Spectrum Beta-Lactamase

28 Piperacillin/tazobactam Use Diseases Cost of Amoxicillin/Clavulanate Treatment : 0,83 x 3 x 3,10 x 38 = 293,32 Savings: 293, ,93 = ,61 10,2 % cost reduction / appendicitis episode Episodes Peritoneal perforated appendicitis 9 appendicitis with peritoneal abscess 7 appendicitis without peritonitis 23 Other appendicitis 5 Episodes Treatment length (days) Cost With peritonitis , Without peritonitis ,576.93

COPD Treatment: Guideline adherence #$%$&#'" ($&" #) *+,-+../01 " )23$)4#5&3&4)6 78,*8.+-1 5%3('%" &3#4%3%& 0-9,7 /*,1 %" &:2#3#4;3%<' 3%4#%# 7-0797 /+.

29 COPD Treatment: Guideline adherence #$%$&#'" ($&" #) *+,-+../01 " )23$)4#5&3&4)6 78,* %3('%" &3#4%3%& 0-9,7 /*,1 %" &:2#3#4;3%<' 3%4#%# /+.1 &" )$%=&3) +80/-,0,1 (')5&4#)#4%3)6 7,9*.*,*91 '$&5)" #) 88,7/1 )4&:%%$#4) 7,*,-+ *--1 %$%)%" & 3 *+778, 7,,1 %)#35%3##3#%# %$#& 3& 2 8/ 78.1 $) 4#5& 4)6 0/, )4%3%$#3,*/ %4 & $% =& 3) /1 " )%" #=& 3) +7,0/ +,*1

30 COPD: Antibiotic Treatment. Mild severity Mild risk factors H. influenzae Beta lactam S. pneumoniae Tetracycline M. catarrhalis Trimethoprim/Sulfametoxazol Chlamydia pneumoniae Macrolides Virus Cephalosporins 2-3 gen Telitromycin %" &:##33#4;3%<' 3%4#%# 0, /8+*7 /7/1 3)<& 3&:%# , +7*1 %" &:##33#4 +9,0-0/1 ))#" ) +9 ++/7/+ 0/1 )%=##" ) +7,+7,0.91 &($%" 2# *01 #)$%#33#4;%=&(%%". 77,88 *,1 %" #>%#4) * +,+*0 +91 %=# $&" 2#4 * )$#%:&4) * '3%" )&:%=&3);$#" )&$#" %=$)&4%" + 70., 8.1 #3%5%#4);#" #)4)" + +80/ 8.1 #$& 3&:%#4 + +/ 8.1 3#4%" #24 + /7 8.1 & 3#5#" )%5& #'" + / )$%)4)" + +* " )$& )4)" + 7*+. 8.1

31 COPD: Antibiotic Treatment. Moderate severity Moderate risk factors The ones from Grup A Beta lactams K. pneumoniae Flouroquinolones E. coli Cephaalosporines 2-3 gen Proteus Enterobacter %" &:##33#4;3%<' 3%4#%#& *,*9 /7+1 %" &:##33#4,, +0*. +*81 ))#" ) *9, )<&3&:%#4 *, * #)$%#33#4;%=&(%%" 7/ +7*98/ 9,1 )%=##" ) 7,.70/. 9+1 %=# $&" ## / /.1 #$&3&:%#4 +-,98, /*1 )$#%:&4) +* 9*8, *-1 &($%" 2#4 +8 +,8.- *81 &3#5#" )%&)5&#& -,970+ 7,1 5'3%" )&:%=&3);$#" )&$#". 0.* &:%#33#4 / /00 +/1 <%4&" ##4 * *78, 801 %=$)&4%" 7 9/ )&%:#" )

32 COPD: Antibiotic Treatment. High severity High Risk The one s from Grups A + B Piper/Tazo Cefepime P. aeruginosa Ceftazidime Fluoroquinolones Aminoglycosides Macrolides %" &:##3#4;3%<' 3%4#%# +8, +7/98* /891 ))#" ) *0 /707, )%=##" ) *. +*7+, #)$%#33#4;%=&(%%" * / +9.1 %" &:##33#4 *8 ++/. +,.1 3)<&3&:%#4 7/ *..7, +771 %=# $&" 2#4 7+,8, '3%" )&:%=&3);$#" )&$#" ** 0-1 #$&3&:%#4 +- 9/*. --1 &($%" 2#4 +9 *79*8. -*1 )$#%:&4) +/ +89/8 9*1 #3%5%#4);#" #)4)" ,,1 3#4 %" 2# ,,1 " )$&)4)" 0 70*/+*,,1 )&%:#" ) - 88 *01 %" #>%#4 9 *899* *,1

33 Lower Limb Joint Reimplantation. Adherence to Antibiotic Prophylaxis Protocol General Prophylaxis Cefazolin 2 g i.v. during anaesthesia induction and continue with 1 g/8 h i.v. until 24 h Beta lactams allergy Clindamycin 600 mg i.v. + Gentamycin 5 mg/kg and continue amb Clindamycin 600 mg/8 h until 24 h Suspected S. aureus (MRSA) Trimethoprim/Sulfamethoxazole 160/800 mg i.v. during induction and one dose after 12 h after the initial dose. Allergy: Vancomycin 1 g + Aztreonam 2 g, continue with one dose 8 h after the initial dose.! )% =& 3# #4 %" 2#4 +8,0 %=# $&" 2# )&:##4) +8 7 )&%:#" ) +8 + &5&" 2# )4%" 2#4 +8 +! #$&3&:%#4 9- *. %" &:##33#4;3%<' 3%4#% #,0 */ 5'3%" )&:%=&3);$#" )&$#" /7 7/ <%4&" 2#4,7 ++ %" &:##33#4,/ +8 #)$% #33#4;%=&(%%" 99 9 %=$)&4%",+. 3#4)=& 3# 0*, 3)<& 3&:%#4 +9 * )%=##" ) *7 * " )$&)4)" /* * %&" 2#4 +/ 7 )$#%:&4) // 7

34 Lower Limb Joint Reimplantation. Diagnosis of the Episodes with Ciprofloxacin #4 )#& 4 (%#33' 54)4?!6 + 7 )5)$##%&3##4)#&44) - 5%23&&'5#4)#&44) * 5$)&&'5#4)#&44) + #" 3%4%#&4&$<%5'3%$#4A)$#&4#4)#&4&)$ + #4)$4%3A&#4$&5)5#5#4)#&4 7 $&)'5#4)#&44), &5&)$%#<)#4)#&4&)$ * '$#4%$2$%#4)#&4 4) +-

Erythropoietin use evaluation* " &'()&'* #$ //. +,0 7.-1 %,-8 7*9,0,1 $ +8*. *-.

35 Erythropoietin use evaluation* " &'()&'* #$ //. +, %,-8 7*9,0,1 $ +8*. *-. *9*1 #$ % $ &$+'( &,$+'* //. +-/ *90 ***1.-71,-8 7,9,*+ /+/ *.,*7 -+8, &' (!) +8,B..-/,C!!"#!$!%

36 PPI* Inappropriate Use &66 #6 7#86 *+,-,.,)/,+012*+,-,2*03*2-,

37 Potentially Inappropriate Medication Use in Older Adults* 4#" 1 PIM ) 0*-1.71 /7B*99 Drug % #%=)%".*.1 %" #&%$&4) 7,71 3'&:)#4).+1 %" #$##324) *81 4#)##4) 7-1 #3& ##4) 871 4#$&'$%4&# ' $%=)%" 881 " )23& % 881. /9 3 7.:;7;;&< *&' 3 #= $#<" $">

38 What does EPIMED contribute to the Pharmacy Department? 1 Allows us to convert a lot of information into knowledge, giving the pharmacist the opportunity to add tangible value to the Health Service. 2 Significantly reinforces the vision of the pharmacist as an advisor instead of an auditor. It s well accepted by physicians who actively participate in analysis sessions. 3 Emphasizes the pharmacist s clinical role and team work with clinicians. 4 Introduces the concept of disease management, in addition to drug management, as the only tool to contain costs and, therefore promote sustainability 5 Places the pharmacist in a leading position in clinical management research.

39 A virtuous circle PHARMACY Pharmacoepidemiology Analysis Unit Drug use reports Clinical session Pharmacists + Physicians Implementation of Improvement measures Agreement

40 Some final thoughts It s a misguided policy to give priority exclusively to short-term measures because of the desire for immediate results, thereby discarding the implementation of other measures that are effective only in the mid- or long-term. Acting only in the short-term ensures that you will need new shortterm measures again and again The only way to get sustained results is to combine contemporaneous short-, mid- and long-term measures. When the impact of short-term measures decreases, the mid-term measures are ready to act and the same will occur with long-term measures.

41 The power: the EPIMED network

Recommended Agent First alternative for β-lactam allergy Alternative Agents (in order of preference) document β-lactam allergy for SCIP)

Recommended Agent First alternative for β-lactam allergy Alternative Agents (in order of preference) document β-lactam allergy for SCIP) Surgical Prophylaxis Guideline Updates Wadley Regional Medical Center Surgery and Trauma Committee, July 22, 2014 Pharmacy and Therapeutics Committee, August 2014 Compiled by: Andrea C Jarzyniecki, Pharm