Evaluation of a Novel Web-Based Prior Approval Application for Palivizumab Prophylaxis of Respiratory Syncytial Virus in a State Medicaid Program

Lundeen, Kristin; Pfeiffenberger, Trista; Vann, Julie Jacobson; O'Brien, Timothy; Sampson, Charlene; Wegner, Steven E.

doi:10.18553/jmcp.2013.19.2.115

Cited by 3 publications

(4 citation statements)

References 17 publications

(18 reference statements)

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“…To date, although vaccine decision support has proven effective in other settings, there are no reports of EHR-embedded alerts or workflow-based clinical decision support (CDS) interventions to improve palivizumab administration rates [17][18][19]. The only identified CDS intervention describes an online web application to streamline the prior-authorization process and to send monthly dose prompts to pediatricians [20]. We hypothesized that CDS tools would be effective in improving palivizumab receipt.…”

Section: Introductionmentioning

confidence: 99%

Clinical Decision Support and Palivizumab

Utidjian¹,

Hogan²,

Michel³

et al. 2015

Appl Clin Inform

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SummaryBackground and Objectives: Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration. Methods: We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons. Results: There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05). Conclusions: Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.

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Section: Introductionmentioning

confidence: 99%

Clinical Decision Support and Palivizumab

Utidjian¹,

Hogan²,

Michel³

et al. 2015

Appl Clin Inform

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“…An analysis of the palivizumab authorization process in the North Carolina Medicaid program indicated that the average number of days to coverage determination for authorization requests was 8.5 days (SD 15.4) for all claims and 18.4 days (SD 12.7) for claims that were escalated for additional medical review. 11 Considering the time required to confirm coverage, early case management efforts and collaboration with the outpatient clinic are critical components in establishing authorization before discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Lundeen, et al found that 62.8% of patients with Medicaid received all of their palivizumab doses within 35 days. 11 Based upon data from a large United States registry, Frogel, et al found that 65.2% – 69.5% of patients received each dose within 35 days. 8 Chan, et al determined that 72% of patients in a large Canadian registry received all doses within 35 days.…”

Section: Discussionmentioning

confidence: 99%

“…Lundeen, et al, Frogel, et al, and Chan et al reported that 61.1%, 79.9% to 82.7%, and 81% of patients received all expected doses, respectively. 7,8,11 After implementing a program to improve education on AAP guidelines and establish approval at a single clinic, Afghani, et al found that 71% of patients received all expected doses. 13 Stewart, et al reviewed private insurance claims and found that 75% of the patients received all doses.…”

Section: Discussionmentioning

confidence: 99%

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Initial Palivizumab Dose Administration in Outpatient Clinic After Hospital Discharge

Stockton

Chen

Jun

et al. 2018

Pediatric Infectious Disease Journal

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Implementation of an initiative with defined workflow, multidisciplinary collaboration, and early case management efforts to obtain insurance authorization increased outpatient administration of first palivizumab doses. Patient adherence improved as demonstrated by more timely receipt of the second palivizumab dose. There was no difference in reimbursement; however, acquisition cost decreased which is valuable considering low reimbursement rates. RSV-positive readmissions did not change significantly.

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Adherence and outcomes: a systematic review of palivizumab utilization

Wong

Lanctôt

et al. 2017

Expert Review of Respiratory Medicine

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Palivizumab is a humanized monoclonal antibody used for respiratory syncytial virus (RSV) prophylaxis. RSV is the primary cause of lower respiratory tract infection in children aged <2 years, and can give rise to high-burden hospitalization and respiratory complications in later life. Adherence to a monthly dosing regimen, both in timing and injection number, is essential to sustain therapeutic levels of palivizumab and maintain protective status. Deviation from the approved dosing schedule may reduce the efficacy of palivizumab and increase the risk of breakthrough RSV infection and hospitalization. Areas covered: There is no standardized definition of adherence to palivizumab treatment. This review addresses the wide variability in defining and reporting adherence to palivizumab prophylaxis across different studies. The review assesses whether a relationship exists in the outcomes reported in studies relative to the monthly adherence protocol as defined in published randomized controlled trials of the efficacy and safety of palivizumab. Expert commentary: Standardized detailed reporting of adherence to palivizumab prophylaxis using consistent definitions will help provide a more robust level of evidence. This information may be important when considering variations in effectiveness, alterations to recommendations and guidelines, and cost-effectiveness of treatment.

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Evaluation of a Novel Web-Based Prior Approval Application for Palivizumab Prophylaxis of Respiratory Syncytial Virus in a State Medicaid Program

Cited by 3 publications

References 17 publications

Clinical Decision Support and Palivizumab

Clinical Decision Support and Palivizumab

Initial Palivizumab Dose Administration in Outpatient Clinic After Hospital Discharge

Adherence and outcomes: a systematic review of palivizumab utilization

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