Racial Disparities in Older Adults: Impact of Medicare Part D

老年人的种族差异：医疗保险 D 部分的影响

基本信息

批准号：
7686479
负责人：
JOSEPH T HANLON
金额：
$ 22.73万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-15 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7686479
关键词：
Action Research Adherence Administrator African American Age Aging Antihypertensive Agents Area Behavioral Biological Blood Pressure Body Composition Cardiovascular Diseases Caucasians Caucasoid Race Chronic Chronic Disease Clinical Research Communication Communities Data Databases Diabetes Mellitus Doctor of Philosophy Dose Drug Prescriptions Effectiveness Elderly Enrollment Epidemiologic Studies Equipment and supply inventories Funding Goals Guideline Adherence Health Health Insurance Health Policy Health Services Health Status Hypertension Income Institute of Medicine (U.S.)Insurance Benefits Insurance Coverage Interdisciplinary Study Intervention Isolated systolic hypertension Knowledge Lead Life Light Lipids Low income Managed Care Medicare Minority Groups Myocardial Infarction Myocardial Ischemia National Institute on Aging Outcome Pathway interactions Pennsylvania Personal Communication Pharmaceutical Preparations Pharmacotherapy Physicians Physiological Policies Policy Analysis Population Population Group Population Study Positioning Attribute Provider Public Policy Qualifying Quality of Care Recording of previous events Research Risk Scientist Subgroup Tennessee Testing Treatment Protocols United States Agency for Healthcare Research and Quality United States Centers for Medicare and Medicaid Services Vulnerable Populations behavioral/social science beneficiary blood pressure regulation cholesterol control cost experience follow-up health disparity high risk hypertension control interest longitudinal design mortality population based population health preference programs public health relevance racial difference social social science research

Action Research Adherence Administrator African American Age Aging Antihypertensive Agents Area Behavioral Biological Blood Pressure Body Composition Cardiovascular Diseases Caucasians Caucasoid Race Chronic Chronic Disease Clinical Research Communication Communities Data Databases Diabetes Mellitus Doctor of Philosophy Dose Drug Prescriptions Effectiveness Elderly Enrollment Epidemiologic Studies Equipment and supply inventories Funding Goals Guideline Adherence Health Health Insurance Health Policy Health Services Health Status Hypertension Income Institute of Medicine (U.S.)Insurance Benefits Insurance Coverage Interdisciplinary Study Intervention Isolated systolic hypertension Knowledge Lead Life Light Lipids Low income Managed Care Medicare Minority Groups Myocardial Infarction Myocardial Ischemia National Institute on Aging Outcome Pathway interactions Pennsylvania Personal Communication Pharmaceutical Preparations Pharmacotherapy Physicians Physiological Policies Policy Analysis Population Population Group Population Study Positioning Attribute Provider Public Policy Qualifying Quality of Care Recording of previous events Research Risk Scientist Subgroup Tennessee Testing Treatment Protocols United States Agency for Healthcare Research and Quality United States Centers for Medicare and Medicaid Services Vulnerable Populations behavioral/social science beneficiary blood pressure regulation cholesterol control cost experience follow-up health disparity high risk hypertension control interest longitudinal design mortality population based population health preference programs public health relevance racial difference social social science research

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项目摘要

DESCRIPTION (provided by applicant): Both hypertension and ischemic heart disease (IHD which includes those with a history of myocardial infarction [MI] or it's risk equivalent diabetes) are more common and more likely to be inadequately controlled in older African Americans when compared to older Caucasians. One key pathway to these racial disparities is greater cost related medication non adherence in older African Americans when compared to Caucasians. Medicare Part D which began January 2006 provides a drug benefit for those enrolled. The impact of this health policy intervention on racial disparities in medication use and control of chronic diseases such as hypertension and ischemic heart disease is unknown. The long-term objective of our proposed study is to reduce racial disparities in health outcomes by examining the impact of this policy intervention of increasing prescription drug coverage among the elderly. Using a longitudinal design we will examine two objectives. Objective 1 is to determine the impact of the Medicare Part D drug benefit intervention on racial differences in the use of antihypertensive medications in those with hypertension and the use of lipid lowering medications in those with IHD (i.e., those with a history of MI and/or diabetes. One specific hypothesis to be tested is that after the Medicare Part D implementation, older Africans Americans in this high risk group will receive more intense antihypertensive regimens than older Caucasians. A second specific hypothesis to be tested is that the disparity in any lipid lowering medication use between Caucasian and African American older adults in these high risk groups will be reduced after Medicare Part D implementation. Objective 2 is to determine the impact of the Medicare Part D drug benefit intervention on racial disparities in the control of hypertension and IHD. One specific hypothesis to be tested is that the disparity in uncontrolled blood pressure between Caucasian and African American older adults with hypertension will be reduced after Medicare Part D implementation. A second specific hypothesis to be tested is that the disparity in uncontrolled lipid levels between Caucasian and African American older adults with IHD will be reduced after Medicare Part D implementation. This study capitalizes on longitudinal data from the ongoing 11 year Medicare population based National Institute on Aging (NIA) funded Health Aging and Body Composition Study. Our multidisciplinary research team has extensive experience conducting health policy analyses, pharmaco-epidemiological studies with geriatric populations, health disparities and cardiovascular disease research and is uniquely positioned to shed light on this critical policy issue. Moreover, our proposed research is responsive to one of the three research action areas (public policy) outlined in PAR 07-379 entitled "Behavioral and Social Science Research on Understanding and Reducing Health Disparities" and will shed light upon the effectiveness of the Medicare Part D intervention to reduce health disparities. This study is also consistent with the interests of the National Institute on Aging's Behavioral and Social Research Program's Health Disparities Initiatives. PUBLIC HEALTH RELEVANCE: Both access to drug therapy treatment and chronic disease guideline adherence are included as part of the recently released list by Centers for Medicare and Medicaid Services (CMS) entitled "Evidentiary Priorities for the Elderly Population". This list provides clinical research topics for which there are significant knowledge gaps. If Medicare Part D reduces racial disparities by increasing access to medication use which leads to better control of hypertension and IHD, then our study will inform other initiatives to expand insurance coverage to other vulnerable populations.

描述（由申请人提供）：高血压和缺血性心脏病（包括具有心肌梗死史的IHD [MI]或危险等效糖尿病）更为普遍，并且与老年白种人相比，非裔美国人老年美国人更有可能受到不足的控制。与高加索人相比，这些种族差异的关键途径是，与高加索人相比，非洲裔美国人的成本相关药物较高。 2006年1月开始的Medicare D部分为入学者提供了药物益处。这种健康政策干预对药物使用和控制慢性疾病（如高血压和缺血性心脏病）的种族差异的影响尚不清楚。我们拟议的研究的长期目标是通过检查这种政策干预措施增加老年人处方药覆盖范围的影响，以减少健康结果的种族差异。使用纵向设计，我们将研究两个目标。 Objective 1 is to determine the impact of the Medicare Part D drug benefit intervention on racial differences in the use of antihypertensive medications in those with hypertension and the use of lipid lowering medications in those with IHD (i.e., those with a history of MI and/or diabetes. One specific hypothesis to be tested is that after the Medicare Part D implementation, older Africans Americans in this high risk group will receive more intense antihypertensive与年龄较大的白种人相比，要测试的第二个特定假设是，在这些高风险组中，在这些高风险组中的脂质降低药物的使用量将在Medicare D Part的实施后降低。 Medicare D部分实施后，高加索和非裔美国人老年人之间的血压不受控制。要测试的第二个具体假设是，在Medicare D Part D实施后，高加索和非裔美国人老年人之间不受控制的脂质水平的差异将减少。这项研究利用了正在进行的11年医疗保险人口老龄化研究所（NIA）资助的健康衰老和身体组成研究的纵向数据。我们的多学科研究团队拥有丰富的经验，可以进行健康政策分析，具有老年人群的药物 - 流行病学研究，健康差异和心血管疾病研究，并且可以独特地阐明这一关键政策问题。此外，我们拟议的研究对题为“理解和降低健康差异的行为和社会科学研究”中概述的三个研究行动领域之一（公共政策）响应，并将阐明医疗保险部分干预措施的有效性，以减少健康差异。这项研究还与国家衰老行为和社会研究计划的健康差异计划的利益一致。公共卫生相关性：包括获得药物治疗和慢性疾病指南的依从性，作为Medicare and Medicaid Services中心（CMS）最近发布的名为“老年人口的证据优先级”的列表的一部分。该列表提供了存在巨大知识差距的临床研究主题。如果Medicare D部分通过增加获得药物使用的机会来减少种族差异，从而更好地控制高血压和IHD，那么我们的研究将为其他计划提供信息，以将保险范围扩大到其他弱势群体。