Changes in Cardiovascular Care and Outcomes in Eight Years after Medicare Part D

Medicare D 部分后八年内心血管护理和结果的变化

基本信息

批准号：
8530126
负责人：
STEPHEN B SOUMERAI
金额：
$ 33.9万
依托单位：
HARVARD PILGRIM HEALTH CARE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-15 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8530126
关键词：
Acute Adherence Admission activity Affect Cardiovascular Diseases Cardiovascular system Caring Cessation of life Clinical Communities Coronary heart disease Cost Measures Cost Sharing Data Diabetes Mellitus Drops Drug Costs Drug Prescriptions Drug Utilization Drug usage Economics Elderly Enrollment Evaluation Event Excess Mortality Expenditure Generic Drugs Health Health Care Costs Health Expenditures Health Services Health Status Heart failure Hospitals Hypertension Inpatients Insurance Insurance Coverage Longitudinal Studies Low income Marketing Measures Medicare Medicine Methods Morbidity - disease rate Names Outcome Outcome Study Outpatients Patients Pharmaceutical Preparations Phase Physicians Policies Population Prevalence Respondent Services Stroke Subgroup Surveys Therapeutic Visit beneficiary coping cost cost effective disability discount experience high risk improved medication compliance mortality non-drug prevent tool treatment strategy trend

项目摘要

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) affects approximately 77% of the elderly, community-dwelling Medicare population and is the largest driver of hospital admissions, deaths, and health expenditures in this group. Since 2006, the subsidized Part D drug benefit has improved the accessibility of needed medications for people in Medicare, but the specific effects on those with CVD are not well-known, in particular in terms of medication adherence, use of health services, and patient outcomes. Moreover, nothing is known about major trends in these outcomes among elderly Medicare enrollees with CVD in the eight years following Part D implementation. Using strong quasi-experimental methods and the nationally-representative Medicare Current Beneficiary Survey (2000-2013), we will identify the population of elderly Medicare patients with CVD during a 14-year period and evaluate immediate and longer-term changes in their utilization and clinical outcomes following Part D. Study measures will include demographic and clinical attributes, drug and non-drug utilization, cost-related medication nonadherence, acute hospital events, and perceived health status. For the period after Part D implementation, we will develop and examine new measures including patient cost-coping strategies, month-to-month adherence, and out-of-plan purchasing. For high-risk CVD patients (those with drug spending near or above the Part D "donut hole" coverage gap threshold), we will estimate changes in outcomes following the sudden 2011 improvement in brand name drug coverage within this coverage gap. In particular, we will examine changes in adherence and CVD treatment intensity for Part D patients in or near the coverage gap, by therapeutic drug class and by brand versus generic status.

描述（由申请人提供）：心血管疾病（CVD）影响约77％的老年人，社区居住的医疗保险人口，是该组医院入院，死亡和健康支出的最大驱动因素。自2006年以来，补贴D部分的药物福利改善了医疗保险人所需的药物的可及性，但是对CVD患者的具体影响并不众所周知，尤其是在药物依从性，使用健康服务和患者结果方面。此外，在D部分实施后的八年中，在CVD老年医疗保险参与者中这些结果的主要趋势一无所知。使用强大的准实验方法和全国代表性的医疗保险当前的受益人调查（2000-2013），我们将在14年期间确定具有CVD的老年医疗保险患者的人群，并评估其利用率的立即和长期变化。事件和感知的健康状况。在第D部分实施后的阶段，我们将制定和研究新的措施，包括患者成本策略，每月遵守和计划外的购买。对于高风险的CVD患者（患有药物支出的患者接近或高于D部分“甜甜圈孔”覆盖差距阈值），我们将在此覆盖范围内的2011年品牌药物覆盖率突然改善后估计结果的变化。特别是，我们将通过覆盖差距，治疗药物类别以及品牌与通用状况的覆盖范围内或附近的D部分患者的依从性和CVD治疗强度的变化。