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Background  The Medication Regimen Complexity Index ( MRCI ) is a 65‐item instrument that can be used to quantify medication regimen complexity at the patient level, capturing all prescribed and over‐the‐counter medications. Although the  MRCI  has been used in several studies, the narrow scope of the initial validation limits application at a population or clinical practice level.    Purpose  To conduct a  MRCI  validation pertinent to the desired clinical use to identify patients for medication therapy management interventions.    Methods  An expert panel of clinical pharmacists ranked medication regimen complexity for two samples of cases: a single‐disease cohort (diabetes mellitus) and a multiple‐disease cohort (diabetes mellitus, hypertension, human immunodeficiency virus infection, geriatric depression). Cases for expert panel review were selected from 400 ambulatory clinic patients, and each case description included data that were available via claims or electronic medical records ( EMRs ). Construct validity was assessed using patient‐level  MRCI  scores, medication count, and additional patient data. Concordance was evaluated using weighted κ agreement statistic, and correlations were determined using Spearman rank‐order correlation coefficient (ρ) or Kendall τ.    Results  Moderate to good concordance between patient‐level  MRCI  scores and expert medication regimen complexity ranking was observed (claims data, consensus ranking: single‐disease cohort 0.55, multiple disease cohort 0.63). In contrast, only fair to moderate concordance was observed for medication count (single‐disease cohort 0.33, multiple‐disease cohort 0.48). Adding more‐detailed administration directions from  EMR  data did not improve concordance.  MRCI  convergent validity was supported by strong correlations with medication count (all cohorts 0.90) and moderate correlations with morbidity measures (e.g., all cohorts; number of comorbidities 0.46, Chronic Disease Score 0.46). Nonsignificant correlation of  MRCI  scores with age and gender (all cohorts 0.08 and 0.06, respectively) supported  MRCI  divergent validity.    Limitations  This study used cross‐sectional, retrospective patient data for a small number of patients and clinical pharmacists from only two universities; therefore, results may have limited generalizability.    Conclusions  The patient‐level  MRCI  is a valid tool for assessing medication regimen complexity that can be applied by using data commonly found in claims and  EMR  databases and could be useful to identify patients who may benefit from medication therapy management.

pharmacotherapy: the journal of human pharmacology and drug therapy

Validation of a Patient‐Level Medication Regimen Complexity Index as a Possible Tool to Identify Patients for Medication Therapy Management Intervention