A prognostic model based on readily available clinical data enriched a preemptive pharmacogenetic testing program

Details

• Alternative Title:
  J Clin Epidemiol
• Personal Author:
  Schildcrout, Jonathan S. ; Shi, Yaping ; Danciu, Ioana ; Bowton, Erica ; Field, Julie R. ; Pulley, Jill M. ; Basford, Melissa ; Gregg, William ; Cowan, James ; Harrell, Frank E. ; Roden, Dan M. ; Peterson, Josh F. ; Denny, Joshua C.
• Description:
  Objective
  
  We describe the development, implementation, and evaluation of a model to preemptively select patients for genotyping based on medication exposure risk.
  
  Study Design and Setting
  
  Using de-identified electronic health records (EHR), we derived a prognostic model for the prescription of statins, warfarin, or clopidogrel. The model was implemented into a clinical decision support (CDS) tool to recommend preemptive genotyping for patients exceeding a prescription risk threshold. We evaluated the rule on an independent validation cohort, and on an implementation cohort, representing the population in which the CDS tool was deployed.
  
  Results
  
  The model exhibited moderate discrimination with area under the receiver operator characteristic curves ranging from 0.68 to 0.75 at one and two years following index dates. Risk estimates tended to underestimate true risk. The cumulative incidences of medication prescriptions at one and two years were 0.35 and 0.48, respectively, among 1673 patients flagged by the model. The cumulative incidences in the same number of randomly sampled subjects were 0.12 and 0.19, and in patients over 50 years with the highest body mass indices, they were 0.22 and 0.34.
  
  Conclusion
  
  We demonstrate that prognostic algorithms can guide preemptive pharmacogenetic testing towards those likely to benefit from it.
  
  
• Subjects:
  Adult Aged Age Factors Decision Support Systems, Clinical Drug Utilization Female Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors Longitudinal Studies Male Middle Aged Models, Statistical Pharmacogenetics Predictive Value Of Tests Prognosis Program Evaluation Proportional Hazards Models Reproducibility Of Results Risk Factors Sex Factors Ticlopidine

  More +
• Source:
  J Clin Epidemiol. 72:107-115.
• Pubmed ID:
  26628336
• Pubmed Central ID:
  PMC4779720
• Document Type:
  Journal Article
• Funding:
  U01 HG007253/HG/NHGRI NIH HHS/United States ; U01HL122904/HL/NHLBI NIH HHS/United States ; UL1 TR000445/TR/NCATS NIH HHS/United States ; U47CI000824/CI/NCPDCID CDC HHS/United States ; UL1TR000445/TR/NCATS NIH HHS/United States ; R01HL094786/HL/NHLBI NIH HHS/United States ; U01 HL122904/HL/NHLBI NIH HHS/United States ; U19 HL065962/HL/NHLBI NIH HHS/United States ; R01 HL094786/HL/NHLBI NIH HHS/United States ; U47 CI000824/CI/NCPDCID CDC HHS/United States ; U19HL065962/HL/NHLBI NIH HHS/United States ; U01 HG008672/HG/NHGRI NIH HHS/United States ; RC2 GM092618/GM/NIGMS NIH HHS/United States ; U01 HG006378/HG/NHGRI NIH HHS/United States ; U01HG006378/HG/NHGRI NIH HHS/United States ; RC2GM092318/GM/NIGMS NIH HHS/United States
• Place as Subject:
  United States
• Volume:
  72
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5d291622bc2bc05ebc47dade5ba205b4ab2cc1e3ec19e20f5a98d0ecf529183b
• Download URL:
  https://stacks.cdc.gov/view/cdc/38371/cdc_38371_DS1.pdf
• File Type:
  [PDF - 1.75 MB ]