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.

项目概要/摘要 出院后住院和药物问题是健康结果不佳的主要风险因素 患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人。增加可预防药物 问题，例如不必要地继续服用具有神经认知副作用的药物、紧急情况 科室就诊、再入院和住院后的费用对于患有老年痴呆症的老年人来说是一个重大负担 ADRD。更好地了解患者和医疗保健因素如何影响药物的使用 住院后的神经认知影响和不良结果将为改善药物治疗的政策提供信息 患有 ADRD 的老年人的相关结果和护理转变。这位 K08 指导的临床科学家 研究职业发展奖申请 (PA-20-203) 旨在支持 Antoinette B. Coe，药学博士、哲学博士、 密歇根大学药学院药剂师科学家和助理教授。科博士的 长期目标是成为一名独立研究者，推进衰老药物使用科学 一项研究计划，展示确保老年人（尤其是老年人）安全有效用药的方法 那些脆弱、认知障碍和患有 ADRD 的人。为了实现这一目标，Coe 博士将开展 该提案的科学目标以及她将获得的稳健的职业发展计划 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，并了解健康和公共政策对 ADRD 结果。这项指导性研究提案的总体科学目标是了解贫困程度如何 老年人住院后与具有神经认知作用的药物相关的结果可以减轻 患有 ADRD 的成年人。该提案利用了两项现有的医疗保险计划和支付政策， 将药物审查作为潜在的解决方案，以减少术后不适当的神经认知药物使用 护理过渡：Medicare D 部分综合药物审查 (CMR) 和 B 部分过渡护理 管理层（TCM）访问。使用具有全国代表性的医疗保险行政数据，具体目标是 如下： 1) 确定患有 ADRD 的老年人使用不当神经认知药物的预测因素 住院治疗，2) 检查患有以下疾病的老年人中药物审查（CMR 和 TCM）的使用情况 住院并评估与其使用相关的因素，以及 3) 测试有效性 对患有 ADRD 的老年人的结果进行全面的药物审查和过渡护理管理 住院后。科博士将在密歇根大学丰富的环境中开展所有工作， 由朱莉·拜纳姆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 R01 级应用测试策略，以增加患有 ADRD 的老年人及其患者的药物审查 护理人员并推动医疗保险政策变化，以确保患有 ADRD 的老年人安全用药。