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Rx16 pdmp wed_330_1_hoppe_2sun_3baumgartner-leichting
This document summarizes a presentation on linking and mapping prescription drug monitoring program (PDMP) data. It discusses the benefits of linking PDMP data to clinical data, including improving patient safety, evaluating prescribing decisions, and assessing the impact of PDMP interventions. It describes challenges with linking data, such as obtaining consent and negotiating data use agreements. It also discusses Washington State's MAPPING OPIOID AND OTHER DRUG ISSUES (MOODI) tool, which integrates PDMP data with other databases to map and target treatment and overdose prevention efforts at the community level.
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Rx16 pdmp wed_330_1_hoppe_2sun_3baumgartner-leichting
- 1. Linking and Mapping PDMPData Presenters: • Jason Hoppe, DO, Emergency Physician and Medical Toxiocologist, University of Colorado and Rocky Mountain Poison and Drug Center • Benjamin Sun, MD, MS, Emergency Medicine Physician, Oregon Health and Science University • Christopher Baumgartner, Drug Systems Director, Washington State Department of Health • Gillian Leichtling, Senior Research Associate, Acumentra Health PDMP Track Moderator: Christopher M. Jones, PharmD, MPH, Director, Division of Science Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and Member, Rx and Heroin Summit National Advisory Board
- 2. Disclosures Christopher Baumgartner; JasonHoppe, DO; Gillian Leichtling; Benjamin Sun, MD, MS; and Christopher M. Jones, PharmD, MPH, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
- 3. Disclosures • All planners/managershereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. • The following planners/managers have the following to disclose: – John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest: Starfish Health (spouse) – Robert DuPont – Employment: Bensinger, DuPont & Associates-Prescription Drug Research Center
- 4. Learning Objectives 1. Explainthe benefits, challenges and opportunities of linking PDMP data to clinical data. 2. Identify the benefits of mapping data to target treatment expansion and overdose prevention efforts. 3. Describe a state GIS mapping tool that integrates PDMP data with existing databases and displays community-level results. 4. Provide accurate and appropriate counsel as part of the treatment team.
- 5. Linking PDMP Data JasonHoppe, DO Department of Emergency Medicine University of Colorado SOM
- 6. Disclosures • Dr. Hoppehas no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services • Dr. Hoppe is supported by a Harold Rogers BJA grant for PDMP research partnership via the Colorado Division of Regulatory Agencies but this presentation does not reflect the opinions of either entity
- 7. Benefits of linkingdata • Maximize possible benefit to public health by translating research findings to clinical practice – Enhance patient safety and individual healthcare experiences – Expand knowledge about diseases and treatments – Strengthen healthcare system efficiency and effectiveness – Help businesses meet customer needs
- 8. Benefits continued • Evaluatethe true value of PDMPs and the impact of PDMP interventions • Help evaluate causation/cause-effect relationship identify modifiable causes • Evaluate prescribing decisions across multiple providers, settings and care organizations • Improve interpretation of PDMP data, risk factors improve decision-making
- 9. Investigator data needs •No identifiable data! • Clinical data – Diagnosis, visits/discharges, meds, risk factors, imaging, past med/social history, drug screens • PDMP data – Patient: Past/future medication use, overlaps, co- prescribing, MME, # of providers/pharm/Rx/$$$ – Prescriber: # Rx, doses/trends in dosing, co- prescribing, comparison to peer group • Time periods (not dates) • Outcomes (clinical and/or PDMP)
- 10. Barriers for PDMPstudies • Informed consent not realistic or efficient • Impractical/impossible to re-contact research subjects • Even if possible, final group may not represent intended group • Need to have reliable, de-identified data sets – Data sets in separate places, correct matching – Waiver of informed consent
- 11. Barriers continued • Statutoryauthority of governing body – Interpretation of law • Hospital and state are legally separate entities – PDMP vendor may be third entity • Multiple data use agreements (DUA) • Payment mechanism • Resources – Little incentive to invest in infrastructure to support research, not the mission of state or PDMP vendor
- 12. Current mechanisms tolink data • PDMP pulls data • Vendor pulls data • Researcher pulls data • Department of public health • Considerations: DUAs, resources, cost, time, PHI protection, data transfer, data accuracy
- 13. Ideal mechanism forlinkage • Collaborative relationships • Within confines of state laws – Legal and regulatory safeguards in place • Timely • Cost effective • Reproducible • Reasonably assures de-identification • Automated data transfer
- 14. Ideal mechanism “A” •Approved investigator requests clinical data for IRB approved study • Verified suitability • Identifies pts and obtains pt info • Accuracy assessed • De-identifies data set • De-identified data set back to investigator Choi et al. (2015), Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency. PeerJ 3:e1506; DOI 10.7717/peerj.1506
- 15. Ideal mechanism “B” •Request clinical or public health data for IRB approved study • Verified suitability • Identifies pts and obtains pt info • Public health data linked to appropriate pt • Accuracy assessed • De-identifies data set • Merged, de-identified data set back to investigator Choi et al. (2015), Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency. PeerJ 3:e1506; DOI 10.7717/peerj.1506
- 16. Honest broker • Layerof protection; HIPAA safe harbor • Individual, organization or system acting as a neutral intermediary to collect/supply data to approved requestors in a way in which it is not reasonably possible to identify participants • Firewall between investigator and identifiable information • Independent of the research team
- 17. Linking PDMP Data BenjaminSun, MD, MPP Oregon Health & Science University
- 18. Disclosures • Dr. Sunis supported by NIH grant R01DA03652 • Dr. Sun has disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
- 19. Learning Objective • Explainthe benefits, challenges and opportunities of linking PDMP data to clinical data.
- 20. The Plan • NIHsupported study to assess the impact of PDMP use of emergency physicians on opioid prescribing and patient outcomes • Collaboration with WA State Department of Health (PDMP) and Health Care Authority (Medicaid) • Beneficiary and physician level linkage of PDMP and beneficiary level data
- 21.
- 22. Challenges • Getting Permission •Getting the Data
- 23. Getting Permission- StateIRB • State IRB – Concerns about patient and provider identifiable information – Proposed complex linkage strategy • PDMP vendor will create encrypted patient and provider identifiers • All files released to research team will have encrypted identifiers, no direct patient identifiers
- 24. Getting Permission- StateIRB • Ambiguity in legislative language – RCW 70.225.040 (4): “The department may provide data to public or private entities for … research… – IRB questioned whether data release by PDMP vendor violates legislation – Department of Health issued memo clarifying PDMP vendor is agent of DOH
- 25. Getting Permission- StateIRB • Limited Resources – Very lengthy turnaround times – Initial review and approval: 9 months – Minimum risk amendment to add additional variables: 6 months
- 26. Getting Permission- DataUse Agreements • Separate DUA required with Department of Health • Requires contracts and legal review on both sides • Very slow: 6 months
- 27. Getting Permission- LessonsLearned • START EARLY – We initiated IRB application 9 months prior to study start; still had ~6 month delays • ACTIVE MANAGEMENT – Get on phone immediately to understand potential barriers – Conference calls when multiple parties involved • USE (AND THANK) YOUR ALLIES
- 28.
- 29. Getting the Data-PDMP • Vendor manages PDMP on behalf of state • PDMP vendor saturated with PDMP core tasks, non-core requests are delayed (2 years) • Other possible solutions – Contract directly with state • Pay existing staff • Hire new staff – Varying ability of state partners to do this
- 30. Getting the Data-PDMP • We are obtaining de-identified, non-linkable PDMP files so that research team can understand data structure • We hope to obtain linkable PDMP files by late summer 2016
- 31. Overall Project Management •Research staff fully occupied preparing Medicaid files for analysis (~500 million lines of data) • Plan to complete 4 analyses that only require data we already have (detour from core questions about PDMP use) • Close contact with sponsor
- 32. Summary • Getting permission –Begin IRB/ DUA process as soon as possible – Actively manage the process • Getting data – Explore all options, including having state personnel prepare data • Treat your collaborators well!
- 33. PDMP Track: Linkingand Mapping PDMP Data Gillian Leichtling – Acumentra Health Chris Baumgartner, WA State Dept. of Health
- 34. Disclosure Statement • GillianLeichtling and Chris Baumgartner have disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.
- 35. Learning Objectives 1. Explainthe benefits, challenges and opportunities of linking PDMP data to clinical data. 2. Identify the benefits of mapping data to target treatment expansion and overdose prevention efforts. 3. Describe a state GIS mapping tool that integrates PDMP data with existing databases and displays community-level results. 4. Provide accurate and appropriate counsel as part of the treatment team.
- 36. MAPPING OPIOID ANDOTHER DRUG ISSUES (MOODI) TOOL Washington State
- 37. WA State UnintentionalPoisonings Workgroup (UPWG) • Began quarterly meetings in June 2008 • Representatives from public & private organizations: • State/local health agencies, tribal authorities, insurers, law enforcement, substance abuse prevention/treatment, poison control, health professional associations, academic institutions, etc… • Developed short-term actions • Increase provider and public education • Identify methods to reduce diversion through emergency departments • Increase surveillance • Support evaluation of practice guidelines for providers treating chronic, non-cancer pain • Support prescription monitoring program
- 38. 2016 Washington StateInteragency Opioid Working Plan 38 Goal 1: Prevent opioid misuse and abuse • Improve prescribing practices Goal 2: Treat opioid dependence • Expand access to treatment Goal 3: Prevent deaths from overdose • Distribute naloxone to people who use heroin Goal 4: Use data to monitor and evaluate • Optimize and expand data sources
- 39. Opioid Plan -Goal 4 Strategies 1. Improve PDMP functionality to document and summarize patient and prescriber patterns to inform clinical decision making 2. Utilize the PDMP for public health surveillance and evaluation 3. Continue and enhance efforts to monitor opioid use and opioid-related morbidity and mortality 4. Monitor progress towards goals and strategies and evaluate the effectiveness of our interventions
- 40. Bureau of JusticeAssistance (BJA) Previous • Category 1: Implementation • FY 2010 • FY 2011 • Both closed Recent • Category 2: Enhancement • FY 2012 • Ends March 2016 Current • Category 3: Data-Driven Approaches • FY 2014 • Jan 2015 – June 2016 40 Harold Rogers Prescription Drug Monitoring Grants to the Washington State Department of Health
- 41. Category 3 HaroldRogers Grant • Data-Driven Multidisciplinary Approaches to Reducing Rx Abuse Program goals: • Pilot innovative approach • Form multidisciplinary action group • Examine multiple data sources • Identify target areas and create data-driven response strategies 41
- 42. Project Implementation Partners 42 WashingtonDept. of Health - PDMP • Oversight, dataset prep Acumentra Health • Project management University of Washington • Analytic guidance Looking Glass Analytics • Mapping tool development
- 43. MOODI Purpose: LocalVisualization • E.g., risky Rx patterns, Rx opioid or heroin overdose hospitalizations and deaths Identify Needs • E.g., buprenorphine access, methadone/OTP, naloxone, PDMP registration, prescription drug disposal sites Identify Resources • E.g., medication-assisted treatment (MAT) “service deserts” with high treatment need and low availability Identify Gaps 43
- 44. Datasets Currently Included •Dispensing records • Prescriber registrationsPDMP • Opioid OD hospitalizations • Opioid OD deathsOverdose • Buprenorphine-waivered physicians • Opioid Treatment Program list • State treatment admissions data MAT • Naloxone sites • Safe Rx drug disposal sitesOther 44
- 45. Supporting Documents Guidancemanual to aid stakeholders in interpretation and prioritizing interventions Technical document with analytic detail 45
- 46.
- 47. MOODI Functionality Users can: Click to see technical details and definitions Zoom in or out Display up to 4 maps simultaneously View results using various denominators (e.g., counts, rates per 1,000 prescriptions, rates per 1,000 population) 47
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- 52. Travel Time toBuprenorphine Prescriber 52
- 53. Availability of OpioidTreatment Programs 53
- 54. Additional Maps • Othermaps look at bup maintenance/long-term treatment, patients in OTP services, PDMP registration, and dot maps for naloxone and Rx drug disposal sites • Maps in progress: – Buprenorphine service availability: considers active/inactive prescribers and caseload – MAT service deserts: shows index score across needs and resources related to MAT
- 55. USING, SUSTAINING, AND EXPANDINGMOODI Stakeholder Examples and Next Steps
- 56. State Stakeholder Examples 56 Medicaid Official Identifiesareas with high opioid issues, few bup prescribers Targets outreach efforts to providers to seek bup waivers Health Officer IDs areas with high rates of high dosage and overlapping benzos Targets prescriber education efforts Behavioral Health Official IDs areas where bup prescribers are providing short-term prescriptions Works to ID barriers to maintenance bup treatment
- 57. Local Stakeholder Examples 57 County Health Officer IDsareas with high rates of overdose and no naloxone Targets pharmacies for naloxone distribution Prevention Coalition Low rates of PDMP registration, high rates of multiple prescriber episodes Implements PDMP registration campaign Police Chief High rates of opioid overdose Seeks funding for first responder naloxone trainings Medical Provider High rates of overdose and Rx risk Convenes local prescriber workgroup with county health officer
- 58. Sustaining/Expanding MOODI Workingon funding to sustain and expand, for example: Show trends over time Add additional opioid-related data Administrative: crime lab, arrests, ER, EMS Survey: BRFSS, statewide student survey 58
- 59. Expanding Stakeholder Groups MOODI infrastructure now in place and may be useful for others, for example: Add marijuana-related data for state groups working on this issue Make platform available to other states 59
- 60. Contact Chris Baumgartner, PMPDirector [email protected] Gillian Leichtling, Mapping Project Manager [email protected] Project Partners WA Department of Health Acumentra Health University of Washington (Caleb Banta-Green, Ryan Hansen) Looking Glass Analytics 60
- 61.
- 62. Linking and Mapping PDMPData Presenters: • Jason Hoppe, DO, Emergency Physician and Medical Toxicologist, University of Colorado and Rocky Mountain Poison and Drug Center • Benjamin Sun, MD, MS, Emergency Medicine Physician, Oregon Health and Science University • Christopher Baumgartner, Drug Systems Director, Washington State Department of Health • Gillian Leichtling, Senior Research Associate, Acumentra Health PDMP Track Moderator: Christopher M. Jones, PharmD, MPH, Director, Division of Science Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and Member, Rx and Heroin Summit National Advisory Board
Editor's Notes
- #9 Workflow, usability and functionality, admoption and usage, technology and vendors, Longitudinal records and rigorous methods
- #10 Limited data set Could also imagine pharmacy evaluations of PDMP use
- #11 Secondary use of healthcare data: research not planned when data were originally collected and stored
- #17 Bridging the gap for data or specimens- not human research Master patient identifier in order to link across data sources, can update information over time UPMC, Miss, MI, CHOP, Duke, U of Florida, U of Ark, Ohio State, U of CA, National Jewish, U of Chicago
- #38 I wanted to begin this talk with a bit of history about how this work started. Back in 2008, the Washington State Department of Health began a quarterly workgroup in June 2008 focused on preventing prescription, misuse, abuse and overdose. The purpose of the group was to coordinate the prevention activities already underway, set up a forum for continuing communication, and to come up with short term actions that we could work on together. I’ve included examples of who is represented on the workgroup. It is relevant to this discussion to point out that there were several emergency department physicians who attended these meetings. During the first few meetings we developed a charter, which outlines the short term actions.
- #45 Note about opioid overdose: users can view prescription opioids and heroin separately and together.
- #48 Note: Can choose from various denominators: e.g., counts, rate per 1,000 opioid prescriptions, rate per 1,000 population.
- #49 Shows a heat map, most common type used in the tool. Unlike boundary maps, it captures variation where it occurs, not just based on arbitrary boundaries. Can zoom in to the neighborhood level. This is possible because the PDMP data include patient latitude/longitude, which DOH fuzzied slightly by randomizing a number of the final digits. In all of the maps, care was taken to preserve confidentiality by using suppression criteria… (describe)… here, uncolored areas have fewer than 100 patients. The big open areas here are mostly national forest, and there’s some frontier land in the east.
- #50 Prescribing risk maps use the same format and color scheme, so they can be compared more easily. And remember, there is a little icon on the legend where users can click and see both a lay description of how the measure was calculated, and more detailed exclusion criteria, etc.
- #51 Shows ability to compare across multiple maps on one screen. The four maps zoom simultaneously so you can compare measures within the same small geographic area.
- #52 Shows a standard rate map, but using patient zip code. We don’t have address- or point-level data for hospitalizations, so we needed to use zip code boundaries. For overdose deaths, we do have patient address, so we can use the more precise heat maps.
- #53 Prescriber locations fuzzied/approximate because not all are public. Describe. Includes optional filter to include only prescribers who accept Medicaid.
- #55 Describe MAT service deserts index further.
- #59 Development funds provided by Harold Rogers grant award, ending June 30, 2016. Additional funds needed to sustain and expand. Describe expansion a little more… also other functions, e.g., ability to layer overdose maps with naloxone dot maps.