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Visualizing patterns of asthma
medication prescribing in the Military
Health System using EventFlow
Tamra Meyer1, Megan Monroe2, Jeff Millstein3,
Suji Xie1, Trinka Coster1
1Pharmacovigilance
Center, Office of the Surgeon General,
Department of the Army;
2 University of Maryland, Computer Science and HCIL;
3Oracle Health Sciences
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Slide 1
23 May 2012May-27-12
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Research Question
Are LABAs being misprescribed in the MHS?
•  Appropriate LABA Prescribing- Ordered Patterns
–  LABA only in conjunction with ICS = LABA/ICS
–  Step-up or step down therapy
•  SABA step-up to ICS step-up to LABA/ICS
•  LABA/ICS step down to ICS and/or SABA
Acronym Alert
ICS: Inhaled Corticosteroid
LABA: Long-acting Beta Agonist
MHS: Military Health System
SABA: Short-acting Beta-Agonist
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Slide 2
23 May 2012May-27-12
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MHS Population
Active duty,
guard, reserves
9.5 million
people have
access to
benefits
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Family member
of active duty,
guard, reserves
Family
member of
retired or
survivor
Retired from
active duty,
guard, reserves
Slide 3
23 May 2012May-27-12
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Data Source
SOURCES
REPOSITORY
DATA MART
ADMIN
CLAIMS
PHARMACOVIGILANCE
DEFENSE APPLICATION
SYSTEM
(PVDAS)
PHARMACY
RECORDS
ELIGIBILITY/
ENROLLMENT
MHS
Data Repository
PII
preprocessor
EHR
110
HOSTS
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Acronym Alert
EHR: Electronic Health Record
PII: Personally Identifiable Information
Slide 4
23 May 2012May-27-12
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Methods
Jan 2006-Jan 2011
174,238
Asthma
patients with a
new LABA Rx
ID
Group
Start
End
1333
LABA_ICS
2006-01-13
2006-02-11
1333
LABA_ICS
2006-02-05
2006-03-05
1333
LABA_ICS
2006-03-03
2006-04-01
1333
SABA
2006-03-03
2006-04-01
1333
ICS
2006-04-01
2006-04-30
1333
ICS
2006-05-01
2006-05-30
1718
SABA
2008-06-23
2008-07-22
1718
ICS
2009-02-10
2009-03-10
1718
LABA_ICS
2009-02-24
2009-03-24
Categorize into
groups and process
file for EventFlow
100
patients
Extract asthma
medications
surrounding LABA Rx
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Slide 5
23 May 2012May-27-12
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EventFlow: Ordered Patterns Are Combined
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Slide 6
23 May 2012May-27-12
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All Asthma Drugs
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Slide 7
23 May 2012May-27-12
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Align on First LABA-ICS
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Slide 8
23 May 2012May-27-12
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View LABA and ICS Only
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Slide 9
23 May 2012May-27-12
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LABA and ICS in Those Who Started With LABA Alone
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Slide 10
23 May 2012May-27-12
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EventFlow Summary
•  Simple data structure
•  Intuitive display
•  Alignment tool was very powerful-quickly and easily
identified possible patterns of suboptimal LABA prescribing
•  Scaling up to larger samples is critical
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Slide 11
May-27-12
23 May 2012
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The Army’s Home for Health…
Saving Lives and Fostering Healthy
and Resilient People
~ Partnerships Built on Trust
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Slide 12
23 May 2012May-27-12