Drug Integration

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• Drug Information Content

Drug Information Content

Motivation

The OMOP documentation provides the following guidance on populating the drug_concept_id field of the drug_exposure table:

"The Drug Concept with the most detailed content of information is preferred during the mapping process. These are indicated in the CONCEPT_CLASS_ID field of the Concept and are recorded in the following order of precedence: ‘Branded Pack’, ‘Clinical Pack’, ‘Branded Drug’, ‘Clinical Drug’, ‘Branded Drug Component’, ‘Clinical Drug Component’, ‘Branded Drug Form’, ‘Clinical Drug Form’, and only if no other information is available ‘Ingredient’. Note: If only the drug class is known, the DRUG_CONCEPT_ID field should contain 0.”

In order to maximize the utility of the records in the drug_exposure table, it is important that selected drug concepts (and their associated concept classes) contain as much information as possible along the following attributes:

1. Ingredient
2. Drug Strength
3. Dose Form
4. Brand Name
5. Quantity Factor
6. Box size
7. Pack content 
8. Supplier

Score

Based on the attributes listed in OHDSI's table of drug classes, we apply precedence scores to each drug concept class, such that 1 is best and 9 is worst.

A site's drug information content score is calculated as:

Scores are graded as follows:

• 1-4: Good
• 5-6: Fair
• 7-9: Poor

Examples

To improve the information content score, drug_concept_ids must be mapped to concepts within higher ranked drug classes. For example:

aspirin (concept_id = 1112807) -----> aspirin 0.1 MG/MG Oral Powder (concept_id = 43816662)

atorvastatin (concept_id = 1545958) -----> atorvastatin 20 MG (concept_id = 1545992)

duloxetine (concept_id = 19060281) -----> duloxetine 60 MG Delayed Release Oral Capsule [Cymbalta] Box of 7 (concept_id = 43296127)

Queries

-- Calculate the average precedence of drug records submitted
WITH drug_class_ranks AS (
  SELECT * FROM (
    SELECT 1 precendence, drug_class_name FROM UNNEST([
      'Branded Pack', 'Quant Clinical Drug', 'Quant Branded Drug', 'Clinical Drug Box',
      'Branded Drug Box', 'Quant Clinical Box', 'Quant Branded Box', 'Clinical Pack Box',
      'Branded Pack Box', 'Marketed Product'
      ]) AS drug_class_name UNION ALL
    SELECT 1 precedence, 'Quant Clinical Drug' drug_class_name UNION ALL
    SELECT 2 precendence, 'Clinical Pack' drug_class_name UNION ALL
    SELECT 3 precendence, 'Branded Drug' drug_class_name UNION ALL
    SELECT 4 precendence, 'Clinical Drug' drug_class_name UNION ALL
    SELECT 5 precendence, 'Branded Drug Component' drug_class_name UNION ALL
    SELECT 6 precendence, 'Clinical Drug Component' drug_class_name UNION ALL
    SELECT 7 precendence, 'Branded Drug Form' drug_class_name UNION ALL
    SELECT 8 precendence, 'Clinical Drug Form' drug_class_name UNION ALL
    SELECT 9 precendence, 'Ingredient' drug_class_name
  )
)
SELECT
    AVG(precendence) average_precendence
FROM drug_exposure de
JOIN concept c
  ON c.concept_id = de.drug_concept_id
LEFT JOIN drug_class_ranks dr
  ON dr.drug_class_name = c.concept_class_id
WHERE c.vocabulary_id IN ('RxNorm', 'RxNorm Extension')
ORDER BY average_precendence ASC;
	

-- Get counts of concept classes
SELECT
  c.concept_class_id, COUNT(*)
FROM drug_exposure de
JOIN concept c
  ON c.concept_id = de.drug_concept_id
GROUP BY c.concept_class_id
ORDER BY COUNT(*) DESC;