305H ProClarity for Pharmacy

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305H ProClarity for Pharmacy

• Alan Celestino, R.Ph.
• Research Pharmacy Specialist
• Pharmacy Benefits Management SHG

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Learning Objectives

• Understand how to access ProClarity data cubes
  and have a knowledge of the terminology used
• Understand how to create custom members and sets
• Understand how to create views and Briefing Books

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Learning Objectives (contd)

• Understand how to export data from ProClarity to
  other Microsoft applications (i.e. Excel /
  PowerPoint)
• Understand the PBM data cube structure
• Understand the PBM Briefing Books

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Organization

• ProClarity definitions
• Brief ProClarity UI overview
• Create custom reports with ProClarity
• PBM data cube structure
• PBM Briefing books
• Create more custom reports based the PBM Briefing
  Books

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Definitions
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Definitions

• Data Cube
• Collection of data that is organized for rapid
  query response and designed for analysis
• Derived from relational tables or a data
  warehouse
• OLAP Client
• Application that enables browsing and analysis of
  data cubes (e.g. ProClarity)

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Definitions

• Briefing Book
• File that contains saved views (reports)
  organized into folders
• Interactive and updates automatically
• Enables those with little or no knowledge of
  ProClarity to view and modify reports
• ProClarity Analytics Server (PAS)
• Software that stores briefing books centrally
• Provides connection to data cubes
• Enables access with a web browser

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Definitions

• Dimension
• A descriptive category by which the numeric data
  of a cube is analyzed, e.g. Time, Location, Drug
• The how or by portion of the analysis, e.g.
  by Station by Month by Drug
• Measure
• The numeric values you want to analyze
• The what portion of the analysis, e.g. Total
  Cost, Total Quantity, Total Rxs, etc.

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Definitions

• Hierarchy
• The organization of data within a dimension
  grouped in levels of most general to most
  specific, e.g. All Time, Year, Quarter, Month
• Level
• A specific layer in a hierarchy, e.g. Month
• Member
• A specific value within a level, e.g. January

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ProClarity Client

• ProClarity Enterprise Agreement (EA)
• Desktop Professional
• Software
• Web Professional
• Web access (rich client)
• Software not required
• Download plug-in if software not installed
• Same functionality as Desktop Professional
• Web Standard
• Web access (thin client)
• Software not required

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Web Access
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PBM Data Cube Structure
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Outpatient Basic Cube Dimensions

• Location
• Nation, VISN/MCG, Facility, Clinic
• Time
• Fiscal Year, Fiscal Quarter, Month
• Drug
• General Class, VA Class, Generic Name, VA Product

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Outpatient Basic Cube Dimensions

• RxType
• Legend, OTC, Brand, Generic
• Fill
• 30-day fill, 60-day fill, 90-day fill
• Mail/Window
• CMOP/Local
• New/Refill/Partial
• National Formulary
• Local Formulary

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Measures Basic

• Rxs
• Day30Rxs
• Unique Patients
• Day Supply
• Quantity
• Cost

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Measures Calculated

• Cost/Day
• Cost/Day30Rx
• Cost/Unique Patient
• Cost/Rx
• Cost/Unit
• Day30Rxs/Unique Patient
• Rxs/Unique Patient

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Measures Calculated

• Day30RxsAll Drug
• Day30Rxs for selected drug as a of Day30Rxs for
  all drugs in the Drug dimension.
• Day30RxsParent
• Day30Rxs for selected drug as a of Day30Rxs for
  its parent in the Drug dimension.

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Measures Calculated

• Unique PatientsAll Drug
• Unique Patients for selected drug as a of
  Unique Patients for all drugs in the Drug
  dimension.
• Unique PatientsParent
• Unique Patients for selected drug as a of
  Unique Patients for its parent in the Drug
  dimension.

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Measures Calculated

• RxsAll Drug
• Actual Rxs for selected drug as a of Actual Rxs
  for all drugs in the Drug dimension.
• Total CostAll Drug
• Total Cost for selected drug as a of Total Cost
  for all drugs in the Drug dimension.
• Dose/Day
• (QuantityStrength)/Day Supply for oral tablets
  and capsules only

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PBM ProClarityBriefing Books
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Briefing Books Overview

• FY07 National Monitors (25 views)
• Deputy Under Secretary for Health for Operations
  and Management Monitors For FY 2007.
• Global Measures (25 views)
• Views of overall drug utilization, such as
  cost/30-day Rx by month and top 25 drugs by total
  cost for a quarter.

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Briefing Books Overview

• Drug Utilization (94 views)
• Views of specific drug utilization as 30-day Rxs
  of drug class or of all drugs as appropriate.
• Tablet Splitting (28 views)
• Views of adherence to tablet splitting and
  related measures for specific drugs.

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Drug UtilizationBriefing Book
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Drug Utilization Views

• (Drug) Day30Rxs Class
• (Drug) Day30Rxs All Drug
• Day30Rxs
• Corrects for differences in multi-month
  dispensing
• All Drug
• Provides a common denominator for comparing
  VISNs/Facilities of different sizes
• Class
• Corrects for differences in patient populations

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Drug Utilization Contents

• ACEs
• Alpha Antagonists
• ARBs
• Atypical Antipsychotics
• CCBs
• COX-2s
• HMGs
• NSAHs

• Ophthalmic Prostaglandins
• Opioids
• PDE-5s
• PPIs
• SSRIs
• Triptans
• TZDs
• Misc

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Tablet SplittingBriefing Book
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Tablet Splitting Formulas

• Split Rxs
• Formula ½ tab once daily (qty/days supplylt1)
• Rxs that are currently being split (exactly in
  half to get the dose)
• Non-Split Rxs
• Formula 1 tab once daily (qty/days supply1)
• Rxs that are not currently being split, but can
  potentially be split (exactly in half to get the
  dose)
• Splittable Rxs
• Formula (Split Rxs Non-Split Rxs)
• Rxs that can potentially be split (exactly in
  half to get the dose)
• Adherence
• Formula Split Rxs /(Split Rxs Non-Split Rxs)

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Tablet Splitting Limitations

• Must assume all are Once Daily
• Example Once Daily drug dosed Twice Daily
• Qty 30, Days Supply 30 (Tablet Splitting)
• Counts as Non Split
• Exception Carvedilol
• Assume all are Twice Daily
• Similar problem occurs if dosed Once Daily

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Tablet Splitting Contents

• Atorvastatin
• Carvedilol
• Citalopram
• Losartan
• Paroxetine
• Sertraline
• Simvastatin

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Tablet Splitting Views

• Views are centered around the percent adherence
  to tablet splitting
• Includes information needed to decide how
  aggressively to pursue a tablet splitting
  strategy
• Percentage of all Rxs that are splittable
• e.g. If one drug has 40 of its Rxs splittable
  and another drug has 80 of its Rxs splittable,
  want to pursue drug with more splittable Rxs
• Savings per Rx by tablet splitting
• Volume of the drug (from cube)

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Tablet Splitting Views

• (Drug) Split Day30RxsSplittable
• This is Adherence to Tablet Splitting, which is
  Day30Rxs that are currently being split /
  Day30Rxs that can potentially be split (exactly
  in half to get the dose).
• (Drug) Splittable Day30RxsAll (Drug)
• Since not all Rxs will be able to be split in
  half to get the desired dose, this shows the
  Day30Rxs that can potentially be split / All
  Day30Rxs for the Drug.

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Tablet Splitting Views

• (Drug) Split vs. Non-Split Cost/Day30Rx
• This shows the Cost/Day30Rx for Split and
  Non-Split Rxs (nationally).
• (Drug) Cost/Day30Rx Difference
• This shows the difference (savings) for a Split
  Day30Rx vs. Non-Split Day30Rx (nationally).

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Miscellaneous

• OLAP Online Analytical Processing
• VA ProClarity software download link
  http//vhaaacapp3.vha.med.va.gov/proclarityea/

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VISN Level Cube Structure

• Outpatient Pharmacy
• FY07
• Melody Darbe, MSN
• Information Analyst

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VISN Level Cubes

• Flexibility
• Add dimensions or measures
• Using Pharmacy data or Other Clinical Data
  pertinent to Pharmacy patients.
• Remove dimensions or measures
• When improvement occurs focus can be turned to
  other areas.

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Additional Dimensions

• Age
• Active Rx
• Allergy
• Dx
• Lab

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Age

• Two Hierarchies use with Unique Patient measure
• Age Decade
• Provides 11members
• lt20, 20-29,30-39 and so on to gt100 and Unknown
• Age SixtyFive
• Provides 3 members
• lt65, 65, Unknown

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Active Rx

• Defined as active or suspended scripts in last
  395 days (Supplies not included) Use with
  Unique Patient Measure
• Counts Number of Distinct Scripts per patient at
  the National Drug Name Level.
• Members Include
• lt 9 Scripts
• 10-19 Scripts
• gt 20 Scripts

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Provider List
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Allergy

• Identifies if Allergy assessment is documented.
  Use with Unique Patient Measure
• Members
• Documented
• Needed

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Diagnoses (Dx)

• Patient Cohorts (Member Y or N) (All primary ICD
  9 codes for outpatient encounters in the last 2
  years. Patient must have at least two visits
  with the Cohort definition.)
• Diabetes (250)
• Hypertension (401)
• Ischemic Heart Disease (IHD) (414,428,410)
• PTSD (309)
• Schizophrenia (295)

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Diagnoses (Dx) Continued

• Mental Health Patient (MHPt)
• DSS ID between 500-599, Count clinic only, One
  visit needed.

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Lab Values Clinical Cohorts

• HgbA1c Results
• Diabetics
• Patients on Atypical Antipsychotic Medications
• LDL Results
• Diabetics
• Ischemic Heart Disease (IHD)
• Patients on Atypical Antispychotic Medications

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Lab Values Clinical Cohorts

• INR
• Warfarin review

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Diabetic Patients with Last A1C Result in Last 6
Months
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Diabetic Patients on Hypoglycemic Medications
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Diabetic Patients on Hypoglycemic Medications
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HgbA1c Result by Glipizide Strength
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HgbA1c Result by Glyburide Strength
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HgbA1c Result by Rosiglitazone Strength
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Diabetic Patients on Antilipemic Medications
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LDL Result by Simavastatin Strength
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Ischemic Heart Disease Patients on Antilipemic
Meds
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Ischemic Heart Disease Patients on Antilipemic
Meds
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Effects of Atypical Antipsychotic Meds on LDLs
All Patients
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Warfarin and INR Results
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New Areas of Interest

• Hgb and Epoetin Patients
• Add HgbA1c to include result in last 12 months

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VISN Level Cube

• Questions