USING LARGE DATABASES AND COMPUTERSTO STUDY HEALTH PROBLEMS

and

July 12, 2010

University of Mississippi School of Pharmacy

• 6 academic departmentsMedicinal Chemistry, Pharmaceutics, Pharmacognosy, Pharmacology,

Pharmacy Administration, Pharmacy Practice

• 2 research centers in the Research Institute of Pharmaceutical Sciences (RIPS)

National Center for Natural Products Research (NCNPR)

Center for Pharmaceutical Marketing and Management Research (CPMM)

Slide 2

CPMM/PHAD research project staffing• RIPS/ CPMM personnel

• 2 Research faculty (PhD) – all have joint appointment in Pharmacy Administration

• 2 Support staff

• Pharmacy Administration personnel• 6 Faculty (PhD) – all have joint appointment in CPMM• 14 MS and PhD graduate students (7 receive stipend support from RIPS and

CPMM)

• Close collaborative relationship with Medical Marketing and Economics (MME) a local pharmaceutical marketing consulting company (4 of 5 starting partners are PHD graduates of Pharmacy Administration department)

Slide 3

We do research on a broad assortment of topics?We study everything related to:• The selection and use of pharmaceutical products.

• Medication use patterns and trends in markets.• How marketing affects product selection.• How product selections are made and what influences the decisions of

the various players involved.• How medication use and use behaviors (e.g., compliance) affect health

outcomes.

• The development and provision of pharmacy services.• Pharmacists job satisfaction.• What services are being delivered and by whom.• How to better deliver pharmacy services.• The economic viability of community pharmacies.• How pharmacy services affect health outcomes.

Slide 4

Research with administrative claims data is becoming an increasingly important area

• FDA Sentinel program launched recently to identify and evaluate potential safety problems with approved drugs.

• Medicare and PBMs evaluating cost/outcomes of plan designs in order to determine the most cost-effective coverage.

• CMS-Medicare identifying effective medication use quality measures for intervention through Quality Improvement Organizations.

• AHRQ and other organizations interest in comparative effectiveness studies for treatment alternatives – medications within class and medications across classes.

• Gradual movement toward true “evidence-based” medical decision making.

Slide 5

CPMM -- building access for UM researchers to administrative claims data

• Current data repositories:• 2002 – 2004 MS Medicaid data for all beneficiaries – installed and

operational.• 2006 – 2007 Medicare data for 5% national sample of beneficiaries –

installed and operations.

• Other data being obtained this year (target date of Octorber):• 2005 – 2007 MS Medicaid data for all beneficiaries.• 2004 – 2007 Medicare data for MS residents• 2008 Medicare data for 5% national sample of beneficiaries.

Slide 6

Major technology challenges with pharmacoepidemiology research

• Data management of large multiple linked files• Typical health administrative claims data files

• Beneficiary information• Prescription drug claims• Institutional short-stay inpatient claims• Institutional outpatient claims• Medical care claims• Long-term care claims

• Any number of claims of each type for each beneficiary• Millions of beneficiaries

• HIPAA and the Privacy Rule• “Research identifiable data” standards

Slide 7

CPMM procedure for research repositories containing personal health information (PHI)

Identifier fields encrypted and modified as needed to create limited data set files.

Identified PHI data obtained on CD / DVD

Original disks stored in safe

When DUA expires, disks are returned or destroyed – files on

research network deleted.

Data moved to restricted network

using external physical device.

Data accessed and analyses run on

restricted network server.

Restricted Network Computer

(maintained by CPMM)

Authorized Researchers

Only output files can be

downloaded for report

development.

Stand-alone Secure Computer(maintained by CPMM)

Slide 8

Examples of Recent and Current Projects

Pharmacoepidemiology projects funded during last two years• Intervention and Support Work Using Integrated Medicare Data

(funded by CMS – IQH)

• Examined hospitalization, ED visits and death related to proposed medication use quality measure for the Medicare program.

• Examination of Medication Use Quality Measures in Mississippi Medicaid Population (funded by CMS-ORDI).• Examined hospitalization, ED visits and death related to proposed

medication use quality measure for the Medicare program.

• Using Medicare Claims Data to Evaluate Medication Utilization and Safety in the Elderly Population (funded by HRSA-OHIT) currently underway

• Examining changes in medication use behaviors and health outcomes related to patients entering the doughnut hole for Medicare Part D coverage.

• Examining the use of Medicare claims data for assessing FDA safety signals.

Slide 10

Pharmacoepidemiology projects funded during last two years

• Using Medicare/Medicaid Claims Data to Support Medication Outcomes and Pharmacovigilance Research (funded by CMS-ORDI) currently underway

• Examining the application of national pharmacy quality measures among Mississippi pharmacies using Medicaid and Medicare data.

• Examining the effect of the Mississippi Medicaid prescription cap on medication use behaviors and outcomes.

• Evaluating the relationships among medication utilization and adherence and health outcomes in elderly, post myocardial infarction (MI) patients as secondary prevention following a myocardial infarction.

• Database Study to Evaluate the Impact of Multiple Sclerosis in a Medicare Patient Population (funded by EMD Serono) contract currently being finalized

• Will examine treatment patterns, adherence and outcomes among Medicare beneficiaries with multiple sclerosis.

Slide 11

Podium presentation: 2009 International Society for Pharmacoeconomics and Outcomes Research, Orlando, FL.

Presenters: Yi Yang, Vennela Thumula, Pat Pace, Ben Banahan, Noel Wilkin, Bill Lobb

Slide 12

Poster presentation: 2009 International Society for Pharmacoeconomics and Outcomes Research, Orlando, FL.

Presenters: Krutika Jariwala, Ben Banahan, Yi Yang, Pat Pace

Slide 13

Poster presentation: 2009 International Society for Pharmacoeconomics and Outcomes Research, Orlando, FL.

Presenters: Yi Yang, Vennela Thumula, Pat Pace, Ben Banahan, Noel Wilkin, Bill Lobb

Slide 14

Poster presentation: 2010 American Pharmacists Association Annual Meeting, Washington, DC.

Presenters: Matt Hill, Yi Yang, Vennela Thumula, Pat Pace, Ben Banahan, Noel Wilkin

Slide 15

Poster presentation: 2010 International Society for Pharmacoeconomics and Outcomes Research, Atlanta, GA.

Presenters: Ben Banahan, Clive Mendonca, Amod Athavale, John Bentley

Slide 16

Poster presentation: 2010 International Society for Pharmacoeconomics and Outcomes Research, Atlanta, GA.

Presenters: Ben Banahan, Pat Pace

Slide 17

Questions

and

Comments