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Utah’s APCD as a Stand-alone Opioid Monitoring Tool

This article explores Utah's All Payer Claims Database (APCD) as a potential stand-alone tool for monitoring opioid use and prescription patterns. It compares the APCD to the Controlled Substance Database (CSD) and discusses data quality, measurement results, and potential future applications.

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Utah’s APCD as a Stand-alone Opioid Monitoring Tool

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  1. Utah’s APCD as a Stand-alone Opioid Monitoring Tool Office of Health Care Statistics Utah Department of Health

  2. Introduction Sterling Petersen, Analytics Lead Office of Health Care Statistics Utah Department of Health sterlingpetersen@utah.gov

  3. Office of Health Care Statistics (OHCS) • Housed within the Center for Health Data and Informatics (CHDI) at the Utah Department of Health (UDOH) • Collects, analyzes, and disseminates data • Healthcare Facility Discharge Data • Inpatient (1992–Current) • ED (1996–Current) • Ambulatory Surgery (1996–Current) • APCD (2013–Current) • HEDIS • CAHPS

  4. All Payer Claims Database (APCD) • Submitted on a monthly basis, processed bi-annually • 2013–Current • Anticipate moving to quarterly processing 2019Q1 • About 40 data streams • Covers approximately 75% of the commercial market • Medicaid • About 2/3 of Medicare Advantage/Part C market • Unknown portion of the Medicare Part D market

  5. Controlled Substance Database (CSD) • Utah’s prescription drug monitoring program (PDMP) • Maintained by the Division of Occupational and Professional Licensing (DOPL) at Utah Department of Commerce • Collects dispensing information on Schedule II–V drugs • Retail pharmacies • Institutional pharmacies • Outpatient hospital pharmacies • In-state/Out-of-state mail order pharmacies

  6. Data Release Policies • All Payer Claims Database (APCD) • Datasets available for internal and external researchers after approval • “Limited Use” • “Research” • Controlled Substance Database (CSD) • Datasets available for internal researchers at the Utah Department of Commerce and the Utah Department of Health after approval • Narrow access provision for external partners

  7. APCD as a Stand-alone Opioid Monitoring Tool? • Coverage • APCD • Most commercial, Medicaid, some Medicare • CSD • All commercial, Medicaid, Medicare, cash-pay

  8. APCD as a Stand-alone Opioid Monitoring Tool? • Data Quality • APCD • Continuous quality monitoring by internal and external personnel • Feedback from external data users • Linked person-centric database • CSD • Enhanced quality monitoring in early stages of development • No built-in longitudinal person identifier

  9. APCD as a Standalone Opioid Monitoring Tool? • Measurement Results - CY2017 • Pharmacy Quality Alliance’s Opioid-Related Measures • Concurrent Use of Opioids and Benzodiazepines (COB) • Use of Opioids at High Dosage in Persons Without Cancer (OHD) (NQF #2940) • Use of Opioids from Multiple Providers in Persons Without Cancer (OMP) (NQF #2950) • Use of Opioids at High Dosage and from Multiple Providers in Persons Without Cancer (OHDMP) (NQF #2951)

  10. Concurrent Use of Opioids and Benzodiazepines (COB) • The percentage of individuals 18 years and older with concurrent use of prescription opioids and benzodiazepines • APCD • 22,682 / 110,889 ≈ 20.5% • CSD • 38,421 / 203,040 ≈ 18.9% • Cancer and hospice exclusion omitted

  11. Use of Opioids at High Dosage in Persons Without Cancer (OHD) • The proportion of individuals from the denominator receiving prescriptions for opioids with a daily dosage greater than 120 morphine milligram equivalents (MME) for 90 consecutive days or longer • APCD • 5,788 / 105,424 ≈ 5.5% • CSD • 10,304 / 192,763 ≈ 5.3% • Cancer and hospice exclusion omitted

  12. Use of Opioids from Multiple Providers in Persons Without Cancer (OMP) • The proportion of individuals from the denominator receiving prescriptions for opioids from four (4) or more prescribers AND four (4) or more pharmacies • APCD • 2,856 / 105,424 ≈ 2.7% • CSD • 4,652 / 192,763 ≈ 2.4% • Cancer and hospice exclusion omitted

  13. Use of Opioids at High Dosage and from Multiple Providers in Persons Without Cancer (OHDMP) • The proportion of individuals from the denominator receiving prescriptions for opioids with a daily dosage greater than 120 morphine milligram equivalents (MME) for 90 consecutive days or longer AND who received opioid prescriptions from four (4) or more prescribers AND four (4) or more pharmacies • APCD • 203 / 105,424 ≈ 0.2% • CSD • 382 / 192,763 ≈ 0.2% • Cancer and hospice exclusion omitted

  14. Basic Diagnostics (APCD | CSD)

  15. Basic Diagnostics (APCD | CSD)

  16. Basic Diagnostics (APCD | CSD)

  17. Results by Age Groups (ApCD | CSD)

  18. Conclusion and Looking Forward • Utah’s APCD and CSD yield comparable results for basic measures • We only examined CY2017 due to constraints with the CSD. A multi-year investigation might be useful • Utah’s APCD might be an appropriate alternative to the CSD for some opioid-related analyses

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