HMO Research Network

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Chapter: Pharmacovigilance: Overview of North American Databases

The HMO Research Network is a consortium of 14 health plans that collaborate to perform public domain research.


HMO RESEARCH NETWORK

The HMO Research Network is a consortium of 14 health plans that collaborate to perform public domain research. Each of these health plans has linkable auto-mated pharmacy, claims and membership data, and so are capable of identifying important safety problems within a reasonable time following the marketing of many new drugs. Some also have automated medi-cal records and laboratory data. Ten of the Network plans, with a total population of almost 11 million, have been funded by the US government as a Center for Research and Education in Therapeutics (CERTs), bolstering their efforts to create and maintain the infrastructure needed to support research and educa-tion in therapeutics, including the standardization of data, provision of central programming support and mapping of drugs to a standard formulary (Chan et al., 2005). The HMOs participating in this effort are Harvard Pilgrim Health Care, which leads the CERTs, GHC of Washington State and Northern Idaho, Health Partners Research Foundation in Minnesota, Meyers Primary Care Institute/Fallon Healthcare System in central Massachusetts, Lovelace Health System in New Mexico, UnitedHealthcare, with health plans in several states, and four of the Kaiser Perma-nente HMOs: Kaiser Permanente Northern Califor-nia, KPNW, Kaiser Permanente Georgia and Kaiser Permanente Colorado. Outside of the CERTs and also part of the collaboration are four additional plans: the Henry Ford Health System – Health Alliance Plan in Michigan, Kaiser Permanente Hawaii, Kaiser Permanente Southern California and Scott and White Memorial Hospital in Texas. These remain separate data resources, however, and each HMO can elect to participate, or not, in any given study.

The populations involved are ethnically and geographically diverse; the CERTs HMO Research Network represents approximately 4% of the US population. Membership in the respective health plans remains relatively stable, with annual turnover rates between 10% and 15%. Retention rates tend to be higher among patients with chronic diseases.

With the advent of confidentiality requirements stip-ulated under HIPAA, each participating health plan prepares its own data, stripping them of any patient identifiers while preserving the link between the unique number assigned to each patient and the plan iden-tifier within that plan’s locked file. All dates are converted to age at a certain event (diagnosis, hospital-ization, etc.) to further preserve the patient’s identity. Datasets are prepared and tailored for each protocol. Once formulated and de-identified, they are forwarded to the Channing Laboratory at Harvard for analy-sis. When necessary for confirmation of diagnoses or obtaining information on confounders, medical records can be retrieved at the participating sites.

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