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Predictive Validity of the Beers and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States
Author(s) -
Brown Joshua D.,
Hutchison Lisa C.,
Li Chenghui,
Painter Jacob T.,
Martin Bradley C.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13884
Subject(s) - medicine , beers criteria , emergency department , medical prescription , emergency medicine , drug , prescription drug , medical emergency , geriatrics , family medicine , psychiatry , pharmacology
Objectives To compare the predictive validity of the 2003 Beers, 2012 American Geriatrics Society ( AGS ) Beers, and Screening Tool of Older Persons’ potentially inappropriate Prescriptions ( STOPP ) criteria. Design Retrospective cohort. Setting Managed care administrative claims data from 2006 to 2009. Participants Commercially insured persons aged 65 and older in the United States (N = 174,275). Measurements Association between adverse drug events ( ADE s), emergency department ( ED ) visits, and hospitalization outcomes and inappropriate medication use using time‐varying Cox proportional hazard models. Measures of model discrimination (c‐index) and hazard ratios ( HR s) were calculated to compare unadjusted and adjusted models for associations. Results The prevalence of inappropriate prescribing was 34.1% for the 2012 AGS Beers criteria, 32.2% for the 2003 Beers criteria, and 27.6% for the STOPP criteria. Each set of criteria modestly discriminated ADE s in unadjusted analyses ( STOPP criteria: hazard ratio ( HR ) = 2.89, 95% confidence interval ( CI ) = 2.68–3.12, C‐index = 0.607; 2012 AGS Beers criteria: HR = 2.51, 95% CI = 2.33–2.70, C‐index = 0.603; 2003 Beers criteria: HR = 2.65, 95% CI = 2.46–2.85, C‐index = 0.605). Similar results were observed for ED visits and hospitalizations. The c‐indices increased to between 0.65 and 0.70 in adjusted analyses. The kappa for agreement between criteria was 0.80 for the 2003 and 2012 AGS Beers criteria, 0.58 for the 2012 AGS Beers and STOPP criteria, and 0.59 for the 2003 Beers and STOPP criteria. For the three outcomes, the 2012 AGS Beers criteria had the highest sensitivity (61.2–71.2%) and the lowest specificity (41.2–70.7%), and the STOPP criteria had the lowest sensitivity (53.8–64.7%) but the highest specificity (47.8–78.1%). Conclusion All three criteria were modestly prognostic for ADE s, ED s, and hospitalizations, with the STOPP criteria slightly outperforming both Beers criteria. With low sensitivity, low specificity, and low agreement between the criteria, they can be used in a complementary fashion to enhance sensitivity in detecting ADE s.