Fellow Seattle Children's/UW Medicine Seattle, Washington, United States
Background: Prior authorization (PA) requirements have expanded over the past several decades to impact a larger proportion of procedures and medications. Most physicians report that PAs lead to delays in medical care, and many report that PAs lead to serious adverse events. PAs have been associated with high administrative burden, lower medication adherence, increased healthcare utilization, and delays in care. In the pediatric population, PA requirements have been associated with delays in medication administration and poor clinical outcomes for patients with inflammatory bowel disease and epilepsy. Though there is growing evidence of the burdens associated with PAs, there are few studies quantifying these impacts in pediatric patients and no reported data on the impact of PAs in pediatric nephrology patients. Objective: The primary objective of this study is to assess how PA requirement impacts time to medication administration for infusible medications in pediatric nephrology patients. This study will compare time from infusible medication order to administration between patients who had a PA requirement and those who did not. Secondary objectives include evaluating how more complex PA processes impact time to medication administration and how PA requirement impacts healthcare utilization. Design/Methods: This is a retrospective cohort study utilizing EHR data. We will include patients who received an infusible medication prescribed by a pediatric nephrologist over a four-year period (2020-2024). The exposure of interest is PA requirement and complexity (appeal, peer-to-peer). For each patient, we will extract demographic information, name of infusible medication, time from medication order to administration, indication for medication, and number of emergency room visit and hospitalizations between medication order and administration. Data analysis will include multivariable linear regression to assess the relationship between PA and time to medication administration. This study has been approved as IRB-exempt by the local IRB.
