OBJECTIVES: To examine variation in outpatient prescription use and spending for hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System (VA) and its association with quality measures for these conditions. STUDY DESIGN: Cross-sectional. METHODS: We compared outpatient prescription use, spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal year 2008, including 2.3 million patients dispensed lipid-lowering medications and 981,031 patients dispensed diabetes medications. At each facility, we calculated VAMC-level cost per patient for these medications, the proportion of patients taking brand-name drugs, and Healthcare Effectiveness Data and Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% or not measured). RESULTS: The median cost per patient for lipid-lowering agents in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For diabetes agents, the median cost per patient was $158.34 and varied from $123.34 in the least expensive quartile to $198.31 in the most expensive quartile (P < .001). The proportion of patients dispensed brand-name oral drugs among these classes in the most expensive quartile of VAMCs was twice that in the least expensive quartile (P < .001). There was no correlation between VAMC-level prescription spending and performance on HEDIS measures for lipid-lowering drugs (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10). CONCLUSIONS: Despite the existence of a closely managed formulary, significant variation in prescription spending and use of brand-name drugs exists in the VA. Although we could not explicitly risk-adjust, there appears to be no relationship between prescription spending and quality of care.
OBJECTIVES: To examine variation in outpatient prescription use and spending for hyperlipidemia and diabetes mellitus in the Veterans Affairs Healthcare System (VA) and its association with quality measures for these conditions. STUDY DESIGN: Cross-sectional. METHODS: We compared outpatient prescription use, spending, and quality of care across 135 VA medical centers (VAMCs) in fiscal year 2008, including 2.3 million patients dispensed lipid-lowering medications and 981,031 patients dispensed diabetes medications. At each facility, we calculated VAMC-level cost per patient for these medications, the proportion of patients taking brand-name drugs, and Healthcare Effectiveness Data and Information Set (HEDIS) scores for hyperlipidemia (low-density lipoprotein cholesterol level <100 mg/dL) and for diabetes (glycosylated hemoglobin level >9% or not measured). RESULTS: The median cost per patient for lipid-lowering agents in fiscal year 2008 was $49.60 and varied from $39.68 in the least expensive quartile of VAMCs to $69.57 in the most expensive quartile (P < .001). For diabetes agents, the median cost per patient was $158.34 and varied from $123.34 in the least expensive quartile to $198.31 in the most expensive quartile (P < .001). The proportion of patients dispensed brand-name oral drugs among these classes in the most expensive quartile of VAMCs was twice that in the least expensive quartile (P < .001). There was no correlation between VAMC-level prescription spending and performance on HEDIS measures for lipid-lowering drugs (r = 0.12 and r = 0.07) or for diabetes agents (r = -0.10). CONCLUSIONS: Despite the existence of a closely managed formulary, significant variation in prescription spending and use of brand-name drugs exists in the VA. Although we could not explicitly risk-adjust, there appears to be no relationship between prescription spending and quality of care.
Authors: Elliott S Fisher; David E Wennberg; Thérèse A Stukel; Daniel J Gottlieb; F L Lucas; Etoile L Pinder Journal: Ann Intern Med Date: 2003-02-18 Impact factor: 25.391
Authors: Michael A Steinman; Katherine Y Yang; Sepheen C Byron; Judith H Maselli; Ralph Gonzales Journal: Am J Manag Care Date: 2009-12 Impact factor: 2.229
Authors: Eve A Kerr; Robert B Gerzoff; Sarah L Krein; Joseph V Selby; John D Piette; J David Curb; William H Herman; David G Marrero; K M Venkat Narayan; Monika M Safford; Theodore Thompson; Carol M Mangione Journal: Ann Intern Med Date: 2004-08-17 Impact factor: 25.391
Authors: Julie M Donohue; Nancy E Morden; Walid F Gellad; Julie P Bynum; Weiping Zhou; Joseph T Hanlon; Jonathan Skinner Journal: N Engl J Med Date: 2012-02-09 Impact factor: 91.245
Authors: Thomas R Radomski; Chester B Good; Carolyn T Thorpe; Xinhua Zhao; Zachary A Marcum; Peter A Glassman; John Lowe; Maria K Mor; Michael J Fine; Walid F Gellad Journal: J Manag Care Spec Pharm Date: 2015-12-14
Authors: J Michael McWilliams; Jesse B Dalton; Mary Beth Landrum; Austin B Frakt; Steven D Pizer; Nancy L Keating Journal: Ann Intern Med Date: 2014-12-02 Impact factor: 25.391
Authors: Walid F Gellad; Julie M Donohue; Xinhua Zhao; Maria K Mor; Carolyn T Thorpe; Jeremy Smith; Chester B Good; Michael J Fine; Nancy E Morden Journal: Ann Intern Med Date: 2013-07-16 Impact factor: 25.391
Authors: Vishal Ahuja; Min-Woong Sohn; John R Birge; Chad Syverson; Elly Budiman-Mak; Nicholas Emanuele; Jennifer M Cooper; Elbert S Huang Journal: J Manag Care Spec Pharm Date: 2015-12
Authors: Ilinca D Metes; Lingshu Xue; Chung-Chou H Chang; Haiden A Huskamp; Walid F Gellad; Wei-Hsuan Lo-Ciganic; Niteesh K Choudhry; Seth Richards-Shubik; Hasan Guclu; Julie M Donohue Journal: BMC Health Serv Res Date: 2019-10-16 Impact factor: 2.655