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

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

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

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

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

All Payer Claims Database (APCD) 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

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

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

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)

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

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

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

Cancer and hospice exclusion omitted 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

Basic Diagnostics (APCD | CSD) Age Group Female Male Unknown 18-24 64.9% | 62.1% 35.1% | 37.6% 0.0% | 0.3% 25-34 63.7% | 59.0% 36.3% | 40.6% 0.0% | 0.4% 35-44 59.0% | 56.0% 41.0% | 43.6% 0.0% | 0.5% 45-54 58.5% | 56.2% 41.4% | 43.3% 55-64 56.4% | 53.8% 43.5% | 45.6% 65+ 62.9% | 59.4% 37.1% | 39.9% 0.0% | 0.7% Total 60.1% | 57.1% 39.9% | 42.4%

Basic Diagnostics (APCD | CSD) Age Group Gender Average Total Days Supply Max Total Days Supply Average Unique Days of Service Max Unique Days of Service 18-24 Female 75.8 | 76.6 1527 | 1412 6 | 6 72 | 73 Male 77.9 | 77.0 834 | 803 5 | 5 26 | 47 25-34 128.6 | 126.8 1298 | 1272 7 | 7 81 | 85 137.0 | 136.7 1095 | 1256 61 | 61 35-44 164.6 | 162.1 1065 | 1532 8 | 8 72 | 93 170.3 | 167.3 1118 | 1069 64 | 77 45-54 180.9 | 174.9 1074 | 1109 65 | 67 178.6 | 176.3 1467 | 3114 142 | 354 55-64 182.9 | 173.9 1213 | 1345 59 | 70 181.7 | 177.9 1367 | 1578 59 | 67 65+ 164.2 | 147.1 1039 | 1019 7 | 6 66 | 72 159.9 | 151.2 1332 | 1384 70 | 73

Basic Diagnostics (APCD | CSD)

Results by Age Groups (ApCD | CSD) COB OHD OMP Age Group APCD CSD 18-24 7.7% 8.0% 1.1% 1.3% 6.7% 4.9% 25-34 16.9% 15.8% 4.2% 4.5% 5.9% 35-44 21.9% 20.5% 6.9% 7.1% 4.6% 45-54 24.0% 22.3% 7.6% 2.9% 2.7% 55-64 23.6% 21.6% 7.3% 2.2% 1.8% 65+ 17.4% 16.1% 3.0% 2.8% 1.0% 0.8% Total 21.0% 19.7% 6.3% 6.5% 3.2%

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