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Yi M, Cao Y, Wang L, Gu Y, Zheng X, Wang J, Chen W, Wei L, Zhou Y, Shi C, Cao Y. Prediction of Medical Disputes Between Health Care Workers and Patients in Terms of Hospital Legal Construction Using Machine Learning Techniques: Externally Validated Cross-Sectional Study. J Med Internet Res 2023; 25:e46854. [PMID: 37590041 PMCID: PMC10472173 DOI: 10.2196/46854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Medical disputes are a global public health issue that is receiving increasing attention. However, studies investigating the relationship between hospital legal construction and medical disputes are scarce. The development of a multicenter model incorporating machine learning (ML) techniques for the individualized prediction of medical disputes would be beneficial for medical workers. OBJECTIVE This study aimed to identify predictors related to medical disputes from the perspective of hospital legal construction and the use of ML techniques to build models for predicting the risk of medical disputes. METHODS This study enrolled 38,053 medical workers from 130 tertiary hospitals in Hunan province, China. The participants were randomly divided into a training cohort (34,286/38,053, 90.1%) and an internal validation cohort (3767/38,053, 9.9%). Medical workers from 87 tertiary hospitals in Beijing were included in an external validation cohort (26,285/26,285, 100%). This study used logistic regression and 5 ML techniques: decision tree, random forest, support vector machine, gradient boosting decision tree (GBDT), and deep neural network. In total, 12 metrics, including discrimination and calibration, were used for performance evaluation. A scoring system was developed to select the optimal model. Shapley additive explanations was used to generate the importance coefficients for characteristics. To promote the clinical practice of our proposed optimal model, reclassification of patients was performed, and a web-based app for medical dispute prediction was created, which can be easily accessed by the public. RESULTS Medical disputes occurred among 46.06% (17,527/38,053) of the medical workers in Hunan province, China. Among the 26 clinical characteristics, multivariate analysis demonstrated that 18 characteristics were significantly associated with medical disputes, and these characteristics were used for ML model development. Among the ML techniques, GBDT was identified as the optimal model, demonstrating the lowest Brier score (0.205), highest area under the receiver operating characteristic curve (0.738, 95% CI 0.722-0.754), and the largest discrimination slope (0.172) and Youden index (1.355). In addition, it achieved the highest metrics score (63 points), followed by deep neural network (46 points) and random forest (45 points), in the internal validation set. In the external validation set, GBDT still performed comparably, achieving the second highest metrics score (52 points). The high-risk group had more than twice the odds of experiencing medical disputes compared with the low-risk group. CONCLUSIONS We established a prediction model to stratify medical workers into different risk groups for encountering medical disputes. Among the 5 ML models, GBDT demonstrated the optimal comprehensive performance and was used to construct the web-based app. Our proposed model can serve as a useful tool for identifying medical workers at high risk of medical disputes. We believe that preventive strategies should be implemented for the high-risk group.
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Affiliation(s)
- Min Yi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuebin Cao
- Health Commission of Hunan Province, Changsha, China
| | - Lin Wang
- Beijing Municipal Health Commission, Beijing, China
| | - Yaowen Gu
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueqian Zheng
- Chinese Hospital Association Medical Legality Specialized Committee, Beijing, China
| | | | - Wei Chen
- Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | | | - Yujin Zhou
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenyi Shi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanlin Cao
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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D. Meid A, Wirbka L, Moecker R, Ruff C, Weissenborn M, E. Haefeli W, M. Seidling H. Mortality and Hospitalizations Among Patients Enrolled in an Interprofessional Medication Management Program. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:253-260. [PMID: 37070272 PMCID: PMC10366959 DOI: 10.3238/arztebl.m2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Measures for improving medication safety in outpatient care are often complex and involve medication reviews. Over the period 2016-2022 (with a preceeding one-year pilot phase), an interprofessional medication management program- the Medicines Initiative Saxony-Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN)-was implemented in two German federal states. More than 5000 patients received a medication review by the end of 2019 by a team composed of physicians and pharmacists and were provided with joint, continuous care thereafter. METHODS In the framework of a retrospectively registered cohort study, the mortality and hospitalizations of this population (5033 patients) were studied using routine data from a statutory health insurer (observation period 2015-2019) and compared with those of a control group (10 039 patients) determined from the routine data by propensity score matching. Mortality was compared by survival analysis (Cox regression), and hospitalization rates were compared in terms of event probabilities within two years of enrollment in the medication management program. Robustness was tested in multiple sensitivity analyses. RESULTS Over the observation period, 9.3% of the ARMIN participants and 12.9% of persons in the control group died (hazard ratio of the adjusted Cox regression, 0.84; 95% confidence interval [0.76; 0.94], P = 0.001). In the first two years after inclusion, the ARMIN participants were hospitalized just as often as the persons in the control group (52.4% versus 53.4%; odds ratio from the adjusted model, 1.04 [0.96; 1.11], P = 0.347). The effects were consistent in sensitivity analyses. CONCLUSION In this retrospective cohort study, participation in the ARMIN program was associated with a lower risk of death. Exploratory analyses provide clues to the potential origin of this association.
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Affiliation(s)
- Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Robert Moecker
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Marina Weissenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Hanna M. Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
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Gerharz A, Ruff C, Wirbka L, Stoll F, Haefeli WE, Groll A, Meid AD. Predicting Hospital Readmissions from Health Insurance Claims Data: A Modeling Study Targeting Potentially Inappropriate Prescribing. Methods Inf Med 2022; 61:55-60. [PMID: 35144291 DOI: 10.1055/s-0042-1742671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Numerous prediction models for readmissions are developed from hospital data whose predictor variables are based on specific data fields that are often not transferable to other settings. In contrast, routine data from statutory health insurances (in Germany) are highly standardized, ubiquitously available, and would thus allow for automatic identification of readmission risks. OBJECTIVES To develop and internally validate prediction models for readmissions based on potentially inappropriate prescribing (PIP) in six diseases from routine data. METHODS In a large database of German statutory health insurance claims, we detected disease-specific readmissions after index admissions for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (DM), and osteoporosis (OS). PIP at the index admission was determined by the STOPP/START criteria (Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to the Right Treatment) which were candidate variables in regularized prediction models for specific readmission within 90 days. The risks from disease-specific models were combined ("stacked") to predict all-cause readmission within 90 days. Validation performance was measured by the c-statistics. RESULTS While the prevalence of START criteria was higher than for STOPP criteria, more single STOPP criteria were selected into models for specific readmissions. Performance in validation samples was the highest for DM (c-statistics: 0.68 [95% confidence interval (CI): 0.66-0.70]), followed by COPD (c-statistics: 0.65 [95% CI: 0.64-0.67]), S/AF (c-statistics: 0.65 [95% CI: 0.63-0.66]), HF (c-statistics: 0.61 [95% CI: 0.60-0.62]), AMI (c-statistics: 0.58 [95% CI: 0.56-0.60]), and OS (c-statistics: 0.51 [95% CI: 0.47-0.56]). Integrating risks from disease-specific models to a combined model for all-cause readmission yielded a c-statistics of 0.63 [95% CI: 0.63-0.64]. CONCLUSION PIP successfully predicted readmissions for most diseases, opening the possibility for interventions to improve these modifiable risk factors. Machine-learning methods appear promising for future modeling of PIP predictors in complex older patients with many underlying diseases.
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Affiliation(s)
- Alexander Gerharz
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Felicitas Stoll
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Groll
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
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Meid AD, Gonzalez-Gonzalez AI, Dinh TS, Blom J, van den Akker M, Elders P, Thiem U, Küllenberg de Gaudry D, Swart KMA, Rudolf H, Bosch-Lenders D, Trampisch HJ, Meerpohl JJ, Gerlach FM, Flaig B, Kom G, Snell KIE, Perera R, Haefeli WE, Glasziou P, Muth C. Predicting hospital admissions from individual patient data (IPD): an applied example to explore key elements driving external validity. BMJ Open 2021; 11:e045572. [PMID: 34348947 PMCID: PMC8340284 DOI: 10.1136/bmjopen-2020-045572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore factors that potentially impact external validation performance while developing and validating a prognostic model for hospital admissions (HAs) in complex older general practice patients. STUDY DESIGN AND SETTING Using individual participant data from four cluster-randomised trials conducted in the Netherlands and Germany, we used logistic regression to develop a prognostic model to predict all-cause HAs within a 6-month follow-up period. A stratified intercept was used to account for heterogeneity in baseline risk between the studies. The model was validated both internally and by using internal-external cross-validation (IECV). RESULTS Prior HAs, physical components of the health-related quality of life comorbidity index, and medication-related variables were used in the final model. While achieving moderate discriminatory performance, internal bootstrap validation revealed a pronounced risk of overfitting. The results of the IECV, in which calibration was highly variable even after accounting for between-study heterogeneity, agreed with this finding. Heterogeneity was equally reflected in differing baseline risk, predictor effects and absolute risk predictions. CONCLUSIONS Predictor effect heterogeneity and differing baseline risk can explain the limited external performance of HA prediction models. With such drivers known, model adjustments in external validation settings (eg, intercept recalibration, complete updating) can be applied more purposefully. TRIAL REGISTRATION NUMBER PROSPERO id: CRD42018088129.
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Affiliation(s)
- Andreas Daniel Meid
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Ana Isabel Gonzalez-Gonzalez
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | - Jeanet Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- School of CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Petra Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amstedarm Public Health Research Institute, Amsterdam, The Netherlands
| | - Ulrich Thiem
- Chair of Geriatrics and Gerontology, University Clinic Eppendorf, Hamburg, Germany
| | - Daniela Küllenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amstedarm Public Health Research Institute, Amsterdam, The Netherlands
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Donna Bosch-Lenders
- School of CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hans J Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | - Benno Flaig
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | | | - Kym I E Snell
- Centre for Prognosis Research, School of Primary Care Research, Community and Social Care, Keele University, Keele, UK
| | - Rafael Perera
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
| | - Christiane Muth
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
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Ruff C, Gerharz A, Groll A, Stoll F, Wirbka L, Haefeli WE, Meid AD. Disease-dependent variations in the timing and causes of readmissions in Germany: A claims data analysis for six different conditions. PLoS One 2021; 16:e0250298. [PMID: 33901203 PMCID: PMC8075250 DOI: 10.1371/journal.pone.0250298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospital readmissions place a major burden on patients and health care systems worldwide, but little is known about patterns and timing of readmissions in Germany. METHODS We used German health insurance claims (AOK, 2011-2016) of patients ≥ 65 years hospitalized for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack, or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, or osteoporosis to identify hospital readmissions within 30 or 90 days. Readmissions were classified into all-cause, specific, and non-specific and their characteristics were analyzed. RESULTS Within 30 and 90 days, about 14-22% and 27-41% index admissions were readmitted for any reason, respectively. HF and S/AF contributed most index cases, and HF and COPD accounted for most all-cause readmissions. Distributions and ratios of specific to non-specific readmissions were disease-specific with highest specific readmissions rates among COPD and AMI. CONCLUSION German claims are well-suited to investigate readmission causes if longer periods than 30 days are evaluated. Conditions closely related with the primary disease are the most frequent readmission causes, but multiple comorbidities among readmitted cases suggest that a multidisciplinary care approach should be implemented vigorously addressing comorbidities already during the index hospitalization.
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Affiliation(s)
- Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Andreas Groll
- Faculty of Statistics, TU Dortmund University, Dortmund, Germany
| | - Felicitas Stoll
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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Zülke A, Luck T, Pabst A, Hoffmann W, Thyrian JR, Gensichen J, Kaduszkiewicz H, König HH, Haefeli WE, Czock D, Wiese B, Frese T, Röhr S, Riedel-Heller SG. AgeWell.de - study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients. BMC Geriatr 2019; 19:203. [PMID: 31370792 PMCID: PMC6670136 DOI: 10.1186/s12877-019-1212-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the absence of treatment options, the WHO emphasizes the identification of effective prevention strategies as a key element to counteract the dementia epidemic. Regarding the complex nature of dementia, trials simultaneously targeting multiple risk factors should be particularly effective for prevention. So far, however, only few such multi-component trials have been launched, but yielding promising results. In Germany, comparable initiatives are lacking, and translation of these complex interventions into routine care was not yet done. Therefore, AgeWell.de will be conducted as the first multi-component prevention trial in Germany which is closely linked to the primary care setting. METHODS AgeWell.de will be designed as a multi-centric, cluster-randomized controlled multi-component prevention trial. Participants will be older community-dwelling general practitioner (GP) patients (60-77 years; n = 1,152) with increased dementia risk according to CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score. Recruitment will take place at 5 study sites across Germany. GP practices will be randomized to either intervention A (advanced) or B (basic). GPs will be blinded to their respective group assignment, as will be the statistician conducting the randomization. The multi-component intervention (A) includes nutritional counseling, physical activity, cognitive training, optimization of medication, management of vascular risk factors, social activity, and, if necessary, further specific interventions targeting grief and depression. Intervention B includes general health advice on the intervention components and GP treatment as usual. We hypothesize that over the 2-year follow-up period the intervention group A will benefit significantly from the intervention program in terms of preserved cognitive function/delayed cognitive decline (primary outcome), and other relevant (secondary) outcomes (e.g. quality of life, social activities, depressive symptomatology, cost-effectiveness). DISCUSSION AgeWell.de will be the first multi-component trial targeting risk of cognitive decline in older adults in Germany. Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline. TRIAL REGISTRATION German Clinical Trials Register (reference number: DRKS00013555 ).
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Affiliation(s)
- Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
- Department of Economic & Social Sciences & Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
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Thomas RE, Thomas BC. A Systematic Review of Studies of the STOPP/START 2015 and American Geriatric Society Beers 2015 Criteria in Patients ≥ 65 Years. Curr Aging Sci 2019; 12:121-154. [PMID: 31096900 DOI: 10.2174/1874609812666190516093742] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/07/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Polypharmacy remains problematic for individuals ≥65. OBJECTIVE To summarise the percentages of patients meeting 2015 STOPP criteria for Potentially Inappropriate Prescriptions (PIPs), 2015 Beers criteria for Potentially Inappropriate Medications (PIMs), and START criteria Potential Prescribing Omissions (PPOs). METHODS Searches conducted on 2 January 2019 in Medline, Embase, and PubMed identified 562 studies and 62 studies were retained for review. Data were abstracted independently. RESULTS 62 studies (n=1,854,698) included two RCTs and 60 non-randomised studies. For thirty STOPP/START studies (n=1,245,974) average percentages for ≥1 PIP weighted by study size were 42.8% for 1,242,010 community patients and 51.8% for 3,964 hospitalised patients. For nineteen Beers studies (n = 595,811) the average percentages for ≥1 PIM were 58% for 593,389 community patients and 55.5% for 2,422 hospitalised patients. For thirteen studies (n=12,913) assessing both STOPP/START and Beers criteria the average percentages for ≥1 STOPP PIP were 33.9% and Beers PIMs 46.8% for 8,238 community patients, and for ≥ 1 STOPP PIP were 42.4% and for ≥1 Beers PIM 60.5% for 4,675 hospitalised patients. Only ten studies assessed changes over time and eight found positive changes. CONCLUSION PIP/PIM/PPO rates are high in community and hospitalised patients in many countries. RCTs are needed for interventions to: reduce new/existing PIPs/PIMs/PPO prescriptions, reduce prescriptions causing adverse effects, and enable regulatory authorities to monitor and reduce inappropriate prescriptions in real time. Substantial differences between Beers and STOPP/START assessments need to be investigated whether they are due to the criteria, differential medication availability between countries, or data availability to assess the criteria.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, 3330 Hospital Drive NW, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Bennett C Thomas
- Independent Researcher, 1604 21 Avenue, NW, Calgary, Alberta, T2M1M1, Canada
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