Evaluating an Intervention to Improve Medication Access and Quality of Care for Underserved Populations With Chronic Conditions

评估改善服务不足的慢性病人群的药物获取和护理质量的干预措施

基本信息

批准号：
10708868
负责人：
Anna D Sinaiko
金额：
$ 60.35万
依托单位：
HARVARD SCHOOL OF PUBLIC HEALTH
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-22 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10708868
关键词：
Address Affect Ambulatory Care Area Asthma Atrial Fibrillation Attitude Behavior Belief Black Populations Black race COVID-19 pandemic Caring Characteristics Chronic Chronic Disease Clinical Colorado Data Data Set Diabetes Mellitus Discrimination Disease Disparity population Electronic Health Record Ethnic Origin Focus Groups Frequencies Goals Guidelines Health Health Status Health system Healthcare Systems Hispanic Hispanic Populations Household Improve Access Income Intervention Interview Language Latino Latino Population Learning Link Marketing Measures Medical Medicare Mental Depression Morbidity - disease rate Outcome Patient Preferences Patient-Focused Outcomes Patients Pharmaceutical Preparations Pharmacy facility Policies Population Provider Quality of Care Race Registries Research Residencies Resources Rural Rural Population Sampling Site Structural Racism System Telemedicine Time Travel Trust Underserved Population Universities Variant acute care care episode clinical encounter cost cost estimate data registry data tools demographics design disparity reduction ethnic minority evidence base evidence based guidelines experience health disparity health literacy implementation strategy implementation tool improved longitudinal dataset mortality novel patient population poor health outcome practice factors preference racial minority rural area rural patients rural residence tool treatment choice treatment services

项目摘要

Underuse of evidence-based medications for chronic disease, driven in part by high out-of-pocket (OOP) medication costs, accounts for substantial preventable morbidity and mortality due to exacerbation of chronic illnesses. This underuse, and the resultant adverse health outcomes, are worse for patients who are Black, Hispanic, or Latino, and those who live in rural areas. Addressing gaps in cost information may reduce OOP spending and improve underuse. Sometimes clinicians prescribe more expensive agents when less costly, equally effective medications exist, in part because, until recently, they lacked information regarding what patients must pay for a particular drug. OOP cost information could also help patients and clinicians make treatment choices that are consistent with patient preferences and goals. In 2019, the University of Colorado Health System (UCHealth) implemented in all ambulatory care sites a Real-Time Benefit Tool (RTBT) that shows clinicians a patient’s OOP medication costs—the cost the patient would pay at a pharmacy—in the Electronic Health Record. Medicare policy supports RTBTs and will increase its implementation. Because cost- related medication underuse is significant among racial/ethnic minority and rural populations, a RTBT has the potential to increase guideline-concordant care in these populations and decrease disparities. On the other hand, use of RTBT may be less frequent among populations with chronic conditions who are Black, Hispanic, Latino, or in rural areas due to differences in where care is received (e.g. telemedicine), health literacy and language, cultural identity and norms, medical system behaviors that erode trust, or interpersonal and structural racism within the health care system. The project will focus on patients with asthma, atrial fibrillation, diabetes, or depression—common chronic conditions for which there are both costly and low-cost clinically effective drugs—and measure (1) outcomes among patients who are Black, Hispanic, or Latino, or who live in rural areas and (2) how these outcomes differ compared with other patients with the same chronic conditions. We will use unique UCHealth data linking clinical medication orders, pharmacy claims, patient data (including race, ethnicity, other demographics, and health status), and RTBT data to assess variation in RTBT use and whether the RTBT is associated with patients’ first medication fills. We will use the Colorado All-Payer Claims data and a difference-in-difference design to measure the impact of the RTBT on use of medications consistent with national evidence-based recommendations and on poor health outcomes. We will characterize via interviews and focus groups whether and how RTBT affects experiences, is consistent with patient preferences in their clinical encounters, and the factors associated with positive and negative experiences. This project will produce evidence on the policy impact of an RTBT on access and quality of care for Black, Hispanic, Latino, and rural patients with chronic conditions and on health disparities, and on implementation strategies to maximize impact.

不足以循证用于慢性疾病的药物，部分是由高自付量（OOP）驱动的由于慢性加剧而导致的大量预防发病率和死亡率，占用药物成本疾病。对于黑人患者而言，这种不足以及由此产生的不良健康结果的情况更糟西班牙裔或拉丁裔以及居住在农村地区的人。解决成本信息的差距可能会减少OOP 支出和改善不足。有时，临床医生开处方了昂贵的代理商时，当成本较低时，同样有效的药物存在，部分原因是，直到最近，他们还缺乏有关什么的信息患者必须支付特定药物。 OOP成本信息还可以帮助患者和临床医生做出与患者偏好和目标一致的治疗选择。 2019年，科罗拉多大学卫生系统（UCHealth）在所有门诊护理网站中实施的实时福利工具（RTBT）向临床医生展示患者的OOP药物费用（患者将在药房支付的费用）电子健康记录。 Medicare政策支持RTBT，并将增加其实施。因为成本 - 在种族/族裔少数民族中，相关药物不足是不明显的，RTBT具有在这些人群中增加准则协同保健并减少差异的潜力。另一方面手，在黑人，西班牙裔，西班牙裔慢性病的人群中，使用RTBT的使用频率可能较低拉丁裔或由于收到护理的差异（例如远程医疗），健康素养和语言，文化身份和规范，侵蚀信任或人际关系的医学系统行为卫生保健系统内的结构性种族主义。该项目将集中于哮喘，房颤患者，糖尿病或抑郁症 - 常见的慢性疾病，临床上既昂贵又低成本有效的药物 - 测量（1）黑人，西班牙裔或拉丁裔的患者或居住在粗糙的区域和（2）与其他具有相同慢性疾病的患者相比，这些结果有何不同。我们将使用链接临床药物订单，药房索赔，患者数据（包括）的独特的Uchealth数据（包括种族，种族，其他人口统计和健康状况）和RTBT数据，以评估RTBT使用和 RTBT是否与患者的第一种药物填充有关。我们将使用科罗拉多州的所有付款人主张数据和差异差异设计，以衡量RTBT对使用药物使用一致的影响以国家基于证据的建议和健康状况不佳。我们将通过访谈和焦点小组是否以及RTBT如何影响体验，与患者偏好一致在他们的临床相遇以及与正面和负面经验相关的因素。这个项目将提供有关RTBT对黑人，西班牙裔，拉丁裔的访问和护理质量的政策影响的证据以及患有慢性疾病和健康差异的粗糙患者，以及实施策略最大化影响。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Clinician Response to Patient Medication Prices Displayed in the Electronic Health Record.

临床医生对电子健康记录中显示的患者药品价格的回应。

DOI：
10.1001/jamainternmed.2023.3307
发表时间：
2023
期刊：
JAMA internal medicine
影响因子：
39
作者：
Sinaiko,AnnaD;Sloan,CarolineE;Soto,MarkJ;Zhao,Olivia;Lin,Chen-Tan;Goss,FosterR
通讯作者：
Goss,FosterR