Improving Medication Use and Outcomes in Older Adults with Dementia after Hospitalization: Effectiveness of Medicare Programs

改善老年痴呆症患者住院后的药物使用和结果：医疗保险计划的有效性

• 批准号: 10593952
• 负责人: Antoinette Bartolotta Coe
• 金额: $ 15.52万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593952
• 关键词: Adverse drug event; Adverse effects; Advisory Committees; Affect; Aftercare; Aging; Alzheimer' s disease related dementia; American; Award; Behavioral Model; Caregivers; Caring; Central Nervous System Agents; Clinical; Cognition; Data; Delirium; Dementia; Development Plans; Doctor of Pharmacy; Doctor of Philosophy; Drug Interactions; Education; Effectiveness; Elderly; Eligibility Determination; Emergency department visit; Ensure; Environment; Epidemiology; Exposure to; Female; Goals; Health; Health Policy; Health Services; Healthcare; Hospitalization; Hospitals; Impaired cognition; Income; Inpatients; K-Series Research Career Programs; Logistic Regressions; Low income; Managed Care; Measures; Medicare; Medicare Part B; Mentors; Mentorship; Methodology; Methods; Michigan; Mission; National Institute on Aging; Neurocognitive; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Policies; Public Policy; Quality of Care; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Risk Factors; Science; Scientist; Testing; Training; Universities; Visit; Work; acute care; adverse outcome; beneficiary; career development; college; comorbidity; cost; effectiveness evaluation; effectiveness testing; health service use; hospital readmission; hospitalization rates; improved; indexing; male; member; payment; poor health outcome; primary outcome; professor; programs; public health relevance; racial minority; secondary outcome; statistics

PROJECT SUMMARY/ABSTRACT Hospitalizations and medication problems after discharge are a major risk factor for poor health outcomes in older adults with Alzheimer's disease and related dementia (ADRD). Increased preventable medication problems, such as unnecessary continuation of medications with neurocognitive adverse effects, emergency department visits, readmissions, and costs after hospitalization are a significant burden for older adults with ADRD. A better understanding of how patient and healthcare factors contribute to use of medications with neurocognitive effects and poor outcomes after hospitalization will inform policies to improve medication- related outcomes and care transitions in older adults with ADRD. This K08 Mentored Clinical Scientist Research Career Development Award application (PA-20-203) is to support Antoinette B. Coe, PharmD, PhD, a pharmacist-scientist and Assistant Professor in the University of Michigan College of Pharmacy. Dr. Coe's long-term goal is to become an independent investigator advancing the science of medication use in aging with a research program demonstrating ways to ensure safe and effective medication use in older adults, especially those who are vulnerable, cognitively impaired, and have ADRD. To achieve this goal, Dr. Coe will carry out the scientific aims of this proposal along with a robust career development plan in which she will acquire content expertise in cognitive impairment, ADRD, and aging, gain advanced epidemiology statistics training including causal inference methods, and develop an understanding of health and public policy impact on ADRD outcomes. The overarching scientific goal of this mentored-research proposal is to understand how poor outcomes related to medications with neurocognitive effects after a hospitalization can be mitigated in older adults with ADRD. This proposal leverages two existing Medicare care programs and payment policies that include medication reviews as potential solutions to reduce inappropriate neurocognitive medication use after care transitions: Medicare Part D Comprehensive Medication Reviews (CMR) and Part B Transitional Care Management (TCM) visits. Using nationally representative Medicare administrative data, the specific aims are as follows: 1) Identify predictors of inappropriate neurocognitive medication use in older adults with ADRD after hospitalization, 2) Examine the use of medication reviews (both CMR and TCM) among older adults who have been hospitalized and assess factors associated with their use, and 3) Test the effectiveness of comprehensive medication reviews and transitional care management on outcomes in older adults with ADRD after hospitalization. Dr. Coe will conduct all work at the rich environment of the University of Michigan, with an exceptional mentoring and advisory team led by Dr. Julie Bynum. The study's results will inform a large-scale R01-level application testing strategies to increase medication reviews in older adults with ADRD and their caregivers and motivate Medicare policy changes to ensure safe medication use in older adults with ADRD.

项目摘要/摘要 出院后的住院和药物问题是健康状况不佳的主要危险因素 老年人患有阿尔茨海默氏病和相关痴呆症（ADRD）。增加可预防的药物 问题，例如具有神经认知不良影响的不必要的药物，紧急情况 对于老年人来说 adrd。更好地理解患者和医疗保健因素如何对使用药物使用 住院后的神经认知作用和不良的结局将为改善药物的政策提供信息 - ADRD老年人的相关结果和护理转变。这个K08指导了临床科学家 研究职业发展奖应用程序（PA-20-203）是为了支持Antoinette B. Coe，PharmD，PhD， 密歇根大学药学院的药剂师科学家和助理教授。科博士 长期目标是成为一名独立研究者 一项研究计划，展示了确保老年人安全有效的药物使用的方法，尤其是 那些容易受到伤害，认知障碍并患有ADRD的人。为了实现这一目标，COE博士将执行 该提案的科学目的以及一项强大的职业发展计划，她将在其中获得 认知障碍，ADRD和衰老方面的内容专业知识，获得高级流行病学统计培训 包括因果推理方法，并了解对健康和公共政策的理解 事业结果。这项指导研究建议的总体科学目标是了解贫穷 与较旧的住院后，与具有神经认知作用的药物相关的结果可以减轻 成年人。该提案利用了两个现有的Medicare Care Care计划和付款政策 将药物评论作为潜在的解决方案，以减少不适当的神经认知药物使用 护理过渡：医疗保险D部分全面药物评论（CMR）和B部分过渡护理 管理（TCM）访问。使用全国代表性的Medicare行政数据，具体目的是 如下：1）确定在ADRD老年人中使用不适当的神经认知药物使用的预测指标 住院，2）检查患有药物评论（CMR和TCM）的使用 住院并评估与使用相关的因素，3）测试 关于ADRD老年人的结果的全面药物评论和过渡护理管理 住院后。 Coe博士将在密歇根大学丰富的环境中进行所有工作， 由朱莉·拜纳姆（Julie Bynum）博士领导的杰出指导和咨询团队。该研究的结果将为大规模提供信息 R01级申请测试策略以增加ADRD老年人的药物审查及其 护理人员并激励医疗保险政策改变，以确保ADRD老年人的安全用药使用。