Prior Authorization and Clopidogrel Use - The Truth Lies in the Details
Bibliographic record
Abstract
In the midst of the high-stakes game to reduce heart attacks, Jackevicius et al. reported in October 2008 that “removal of a [prior authorization (PA)] program led to improvement in timely access to clopidogrel for coronary stenting and improved cardiovascular outcomes.”1 In fact, the PA requirement was replaced with a “limited use ” policy for clopidogrel (Plavix) in the Canadian province of Ontario in September 2003, and this policy change was associated with a 4-point decline in major car-diovascular events measured 1 year after hospitalization for acute myocardial infarction and percutaneous coronary intervention (PCI) with stenting among patients aged 65 years or older. Rates of the primary cardiovascular outcome—a composite measure of death, recurrent acute myocardial infarction, repeat PCI, and coronary-artery bypass grafting—were 15 % in the 41-month PA period from April 2000 through August 2003 versus 11 % in the 19-month limited-use period from September 2003 through March 2005 (P = 0.02). Rates of death during the PA period and
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.006 | 0.006 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.024 | 0.032 |
| Insufficient payload (model declined to judge) | 0.007 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".