Quality of Epilepsy Treatment and Costs in Older Americans by Race (QUIET CARE)

按种族划分的美国老年人癫痫治疗质量和费用（安静护理）

• 批准号: 8420004
• 负责人: MARIA PISU
• 金额: $ 42.8万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8420004
• 关键词: Address; Adherence; Adult; Adverse effects; African American; Aftercare; Age; Algorithms; Am 80; American; Antiepileptic Agents; Behavioral Model; Caring; Centers for Disease Control and Prevention (U.S.); Childhood; Cognitive; Data; Data Quality; Development; Disadvantaged; Disease; Elderly; Epilepsy; Event; Goals; Health Care Costs; Health Services Accessibility; Healthcare; Healthcare Systems; Hispanics; Incidence; Institutes; Knowledge; Lead; Life; Literature; Measures; Medicaid; Medical; Medicare; Minority; Minority Groups; National Institute of Neurological Disorders and Stroke; Native Americans; Patients; Personal Satisfaction; Pharmaceutical Preparations; Population; Provider; Public Health; Quality Indicator; Quality of Care; Quality of life; Race; Recurrence; Research; Safety; Seizures; System; Treatment Cost; Treatment Effectiveness; United States Centers for Medicare and Medicaid Services; United States Department of Veterans Affairs; Veterans; age group; base; beneficiary; cost; disorder prevention; experience; follow-up; geographic difference; improved; nervous system disorder; novel; prevent; provider intervention; social; therapy design; treatment adherence

DESCRIPTION (provided by applicant): As of today, we have limited knowledge on the extent to which older Americans with epilepsy, especially typically disadvantaged minorities, receive antiepileptic drug treatment (AED) and follow-up care that is safe and effective. Epilepsy incidence peaks in older age as well as in childhood, and is higher in some minorities; e.g., it is 80% higher in African American (AA) compared to white Medicare beneficiaries. Appropriate treatment is crucial to optimize the chances of seizure control. Based on adult treatment effectiveness and safety data, the Quality Indicators for Epilepsy Treatment (QUIET) were developed in 2007 to assess quality of care. Previous literature suggests not all racial groups receive QUIET concordant care. In addition, poor AED adherence, also typically more common among minorities, limits seizure control. Improving care and adherence to AED treatment in all older adults with epilepsy has the potential to prevent avoidable seizures and also reduce medical costs. Our long-term goal is to inform and design interventions that improve the health care for older minorities with epilepsy and reduce health care costs associated with preventable events. The objective of this application is to examine the current quality of, and adherence to, AEDs and the current quality of care after recurrent seizures across racial groups of older Americans, and to identify opportunities for quality of care improvements and health care costs reductions as a first step toward the long term goal. The rationale for this research is that it is fundamental to inform the progression toward the national objective of living well with epilepsy and potentially reduce health care costs for the hundreds of thousands Medicare beneficiaries who suffer from this disorder. We plan to accomplish our objective by using Medicare administrative claims and a validated algorithm to identify epilepsy cases from these data, to pursue the following specific aims: 1) Assess quality of AED treatment across racial groups of Medicare beneficiaries with epilepsy. Our hypothesis is that, compared to white beneficiaries, typically disadvantaged minorities (e.g., AAs, Native Americans, Hispanics) are less likely to have QUIET concordant AED treatment and less likely to adhere to AEDs; 2) Determine the quality of care after seizure recurrence across race. We hypothesize that minority beneficiaries are less likely to have QUIET concordant care after recurrent seizures. Using the Behavioral Model of Access to Care, analyses for aims 1 and 2 will determine the contribution to racial disparities of, among others, current features of drug plans and geographic variation in care; and 3) determine if lower health care costs are associated with QUIET concordant care across racial groups. If H1-H3 are correct, we hypothesize that minority beneficiaries will be more likely to have high potentially preventable health care costs. This novel project will have a positive impact because it will provide much needed information to move the field toward improving epilepsy care, reducing disparities and potentially reducing costs for older adults. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because understanding whether older adults across minority groups are receiving the care that maximizes the chances of seizure control and good quality of life is expected to inform interventions for providers and/or patients that will ultimately lead to living well with epilepsy, reduce disparities as well as reduce health care costs. Thus, the proposed research is relevant to the National Institute of Neurological Disorders (NINDS)'s objective of assuring a life with "no seizure, no side effects" for all Americans with epilepsy. This is especially important as the US healthcare system deals with an ever increasing number of older adults with epilepsy.

描述（由申请人提供）：截至目前，我们对美国老年癫痫患者（尤其是典型弱势群体）在多大程度上接受安全有效的抗癫痫药物治疗 (AED) 和后续护理的了解有限。癫痫发病率在老年和儿童期达到高峰，并且在某些少数族裔中发病率更高；例如，它是 与白人 Medicare 受益人相比，非裔美国人 (AA) 高出 80%。适当的治疗对于最大限度地控制癫痫发作的机会至关重要。根据成人治疗效果和安全性数据，2007 年制定了癫痫治疗质量指标 (QUIET)，用于评估护理质量。先前的文献表明，并非所有种族群体都能得到安静、一致的护理。此外，AED 依从性差（通常在少数族裔中更为常见）限制了癫痫发作的控制。改善所有老年癫痫患者的护理和 AED 治疗的依从性有可能预防可避免的癫痫发作，并降低医疗费用。我们的长期目标是提供信息和设计干预措施，以改善患有癫痫的老年少数群体的医疗保健，并降低与可预防事件相关的医疗保健成本。此应用程序的目的是检查 AED 的当前质量和依从性，以及美国老年人各种族群体反复癫痫发作后的当前护理质量，并确定改善护理质量和降低医疗保健成本的机会，作为迈向长期目标的第一步。这项研究的基本原理是 对于实现癫痫患者健康生活的国家目标的进展至关重要，并有可能降低数十万患有这种疾病的医疗保险受益人的医疗费用。我们计划通过使用 Medicare 行政索赔和经过验证的算法从这些数据中识别癫痫病例来实现我们的目标，以实现以下具体目标：1) 评估患有癫痫的 Medicare 受益人种族群体的 AED 治疗质量。我们的假设是，与白人受益人相比，典型的弱势群体（例如，AA、美洲原住民、西班牙裔）不太可能接受安静一致的 AED 治疗，也不太可能坚持使用 AED； 2) 确定跨种族癫痫复发后的护理质量。我们假设少数受益人在复发性癫痫发作后不太可能获得安静的一致护理。使用获得护理的行为模型，对目标 1 和 2 的分析将确定药物计划的当前特征和护理的地理差异等对种族差异的影响； 3) 确定较低的医疗保健成本是否与跨种族群体的安静一致护理相关。如果 H1-H3 正确，我们假设少数受益人更有可能 具有潜在的可预防的高额医疗保健费用。这个新颖的项目将产生积极的影响，因为它将提供急需的信息，推动该领域改善癫痫护理、减少差距并可能降低老年人的费用。 公共卫生相关性：拟议的研究与公共卫生相关，因为了解少数群体中的老年人是否正在接受最大限度地控制癫痫和良好生活质量的护理，预计将为提供者和/或患者的干预措施提供信息，这些干预措施最终将导致癫痫患者过得很好， 缩小差距并降低医疗保健费用。因此，拟议的研究与国家神经疾病研究所 (NINDS) 的目标相关，即确保人们的生活“没有 对于所有患有癫痫症的美国人来说，“癫痫发作，没有副作用”。这一点尤其重要，因为美国的医疗保健系统要应对越来越多的患有癫痫症的老年人。