SMI Dual Eligibles and Medicare Part D: Impact on Medications Continuity and Outc

SMI 双重资格和 Medicare D 部分：对药物连续性和 Outc 的影响

基本信息

批准号：
8089422
负责人：
DONALD Michael STEINWACHS
金额：
$ 28.85万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-25 至 2012-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8089422
关键词：
Accounting Acute Adherence Administrator Admission activity Advocate Age Antidepressive Agents Antihypertensive Agents Antipsychotic Agents Behavior Blood Glucose Caring Characteristics Cholesterol Chronic Clinical Collaborations Comorbidity Cost Control Data Diabetes Mellitus Disabled Persons Disease Drug Prescriptions Drug usage Eligibility Determination Enrollment Ensure Experimental Designs Formularies Hospitalization Hypertension Individual Insulin Intervention Interview Life Link Long-Term Effects Major Depressive Disorder Maryland Matched Group Measures Medicaid Medical Medicare Medicare/Medicaid Mental Health Mental disorders Mood stabilizers Outcome Patient Outcomes Assessments Patient Self-Report Patients Pattern Persons Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Policy Maker Population Process Provider Quality of life Randomized Research Sampling Schizophrenia Structure Symptoms Testing Variant adverse outcome base beneficiary comparison group copayment cost design dual eligible experience medication compliance mortality payment prior authorization satisfaction severe mental illness

项目摘要

DESCRIPTION (provided by applicant): The study will examine the impact of Medicare Part D (implemented January 1, 2006) on changes in medications, medications continuity, utilization, cost, and patient-reported outcomes based on an analysis of administrative data (Medicaid and Medicare) for persons with severe mental illnesses (SMI), ages 18-60, disabled, and dually eligible. Their experience and outcomes will be compared with a propensity-score matched group of SMI persons remaining on Medicaid only, in Maryland. The specific aims are to: (1) Develop a set of individual-level access barrier measures that take account of Part D plan provisions (formulary structure, stepped therapy, copayment levels, quantity limits, and prior authorization requirements) that can restrict access to medications, and that can be used as predictors of Part D plan switching for persons with SMI; (2) Examine the relationship between these measures of access barriers and plan switching by individual beneficiaries; (3) Assess the impact of access barrier measures on medications continuity using data on variations among dual-eligibles as well as pre vs. post Part D implementation experience and the matched comparison group of SMI who retained Medicaid drug coverage; and (4) Assess the impact of these access barrier measures on outcomes of care including utilization-based indicators (mental health hospitalization, crisis care), self-report (symptom control, quality of life, satisfaction), mortality, and costs of care by analyzing variations among dual eligibles, and by comparing the dually eligible SMI with the matched group of Medicaid only beneficiaries. To assess short term and longer term effects, a four and a half year post implementation period will be analyzed. Analyses based on administrative data will be supplemented by analyses that incorporate data from in-person interviews of a sample of 450 dually eligible and a propensity-score matched group of 150 Medicaid-only SMI. The interviews will be conducted in early 2010 and will provide self-reported information on outcomes of care (medication continuity, symptom levels, and quality of life). Interview data will also be obtained on covariates not available in administrative data (e.g., living situation) and on factors and processes relating to individuals' decisions to switch their Part D plan enrollment. The findings from the proposed study, being undertaken in collaboration with the Maryland Mental Hygiene Administration, will provide information specific to dually eligible SMI populations that is relevant to policy-makers, Medicare and Medicaid administrators, Part D pharmacy plans, providers, and advocates for persons with mental illness.

描述（由申请人提供）：该研究将研究Medicare D部分（2006年1月1日实施）对药物的变化，药物连续性，利用，成本和患者报告的结果，基于对行政数据（Medicaid和Medicare）的分析（Medicaid和Medicare）对患有严重精神疾病（SMI）（SMI）（SMI）（SMI）（SMI）（SMI）（SMI）（18-60岁）（18-60岁）的人的影响。他们的经验和成果将与仅在马里兰州保留医疗补助的一组倾向得分匹配的SMI匹配的人进行比较。具体目的是：（1）开发一组个人级别的访问障碍措施，这些措施考虑了D部分计划的规定（格式结构，阶梯疗法，共付额，共付额，数量限制和先前的授权要求），可以限制对药物的访问，并且可以用作SMI患者的Part Plan Shistings Shistings smi的预测因素；（2）检查这些访问障碍的措施与计划转换个人受益人之间的关系；（3）使用数据对双重划分的变化以及PER与D部分的实施经验以及保留医疗补助药物覆盖的SMI的匹配比较组评估访问障碍对药物连续性的影响；（4）评估这些访问障碍措施对护理结果的影响，包括基于利用的指标（心理健康住院，危机护理），自我报告（症状控制，生活质量，满意度），通过分析双重竞争物之间的变化以及与双重合格的SMI与匹配的Mediciaries进行比较，通过分析双重差异。为了评估短期和长期影响，将分析实施后四年半。基于行政数据的分析将通过分析补充，这些分析结合了450个双重合格和倾向得分匹配的150个仅150个医疗补助SMI的倾向得分的样本中的数据。访谈将于2010年初进行，并将提供有关护理结果（药物连续性，症状水平和生活质量）的自我报告信息。还将在行政数据（例如生活状况）以及与个人决定切换其D部分计划注册的决定的因素和过程中获得的协变量，也将获得访谈数据。拟议的研究的发现与马里兰州精神卫生管理局合作进行，将提供针对与政策制定者，医疗保险和医疗补助管理人员，D Part Pharmacy Plans，提供者以及精神疾病患者的倡导者有关的双重合格SMI人群的信息。