SMI Dual Eligibles and Medicare Part D: Impact on Medications Continuity and Outc

SMI 双重资格和 Medicare D 部分：对药物连续性和 Outc 的影响

基本信息

批准号：
7870443
负责人：
DONALD Michael STEINWACHS
金额：
$ 69.55万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-25 至 2011-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7870443
关键词：
Accounting Acute Adherence Administrator Admission activity Advocate Age Antidepressive Agents Antihypertensive Agents Behavior Blood Glucose Caring Characteristics Cholesterol Chronic Clinical Collaborations Comorbidity Cost Control Data Diabetes Mellitus Disabled Persons Disease Drug Prescriptions Drug usage Eligibility Determination Enrollment Ensure Experimental Designs Formularies Hospitalization Hypertension Individual Insulin Intervention Interview Life Link Long-Term Effects Major Depressive Disorder Maryland Matched Group Measures Medicaid Medical Medicare Medicare/Medicaid Mental Health Mental disorders Mood stabilizers Outcome Patient Outcomes Assessments Patient Self-Report Patients Pattern Persons Pharmaceutical Preparations Pharmacologic Substance Pharmacy facility Policy Maker Population Process Provider Psyche structure Quality of life Randomized Research Sampling Schizophrenia Structure Symptoms Testing Variant adverse outcome base beneficiary comparison group copayment cost design dual eligible experience medication compliance mortality payment prior authorization satisfaction severe mental illness

项目摘要

DESCRIPTION (provided by applicant): The study will examine the impact of Medicare Part D (implemented January 1, 2006) on changes in medications, medications continuity, utilization, cost, and patient-reported outcomes based on an analysis of administrative data (Medicaid and Medicare) for persons with severe mental illnesses (SMI), ages 18-60, disabled, and dually eligible. Their experience and outcomes will be compared with a propensity-score matched group of SMI persons remaining on Medicaid only, in Maryland. The specific aims are to: (1) Develop a set of individual-level access barrier measures that take account of Part D plan provisions (formulary structure, stepped therapy, copayment levels, quantity limits, and prior authorization requirements) that can restrict access to medications, and that can be used as predictors of Part D plan switching for persons with SMI; (2) Examine the relationship between these measures of access barriers and plan switching by individual beneficiaries; (3) Assess the impact of access barrier measures on medications continuity using data on variations among dual-eligibles as well as pre vs. post Part D implementation experience and the matched comparison group of SMI who retained Medicaid drug coverage; and (4) Assess the impact of these access barrier measures on outcomes of care including utilization-based indicators (mental health hospitalization, crisis care), self-report (symptom control, quality of life, satisfaction), mortality, and costs of care by analyzing variations among dual eligibles, and by comparing the dually eligible SMI with the matched group of Medicaid only beneficiaries. To assess short term and longer term effects, a four and a half year post implementation period will be analyzed. Analyses based on administrative data will be supplemented by analyses that incorporate data from in-person interviews of a sample of 450 dually eligible and a propensity-score matched group of 150 Medicaid-only SMI. The interviews will be conducted in early 2010 and will provide self-reported information on outcomes of care (medication continuity, symptom levels, and quality of life). Interview data will also be obtained on covariates not available in administrative data (e.g., living situation) and on factors and processes relating to individuals' decisions to switch their Part D plan enrollment. The findings from the proposed study, being undertaken in collaboration with the Maryland Mental Hygiene Administration, will provide information specific to dually eligible SMI populations that is relevant to policy-makers, Medicare and Medicaid administrators, Part D pharmacy plans, providers, and advocates for persons with mental illness.

说明（由申请人提供）：该研究将根据管理数据（医疗补助计划）分析，探讨 Medicare D 部分（2006 年 1 月 1 日实施）对药物变化、药物连续性、利用率、成本和患者报告结果的影响。和医疗保险），适用于患有严重精神疾病 (SMI)、年龄 18-60 岁、残疾人和双重资格的人。他们的经验和结果将与马里兰州仅接受医疗补助的 SMI 人群倾向得分匹配组进行比较。具体目标是： (1) 制定一套个人层面的准入障碍措施，考虑 D 部分计划的规定（处方结构、阶梯式治疗、共付水平、数量限制和事先授权要求），限制准入药物，并且可以用作 SMI 患者 D 部分计划转换的预测指标； (2) 检查这些准入障碍措施与个人受益人计划转换之间的关系； (3) 使用双重资格者之间差异的数据以及 D 部分实施前后的经验以及保留 Medicaid 药物承保的 SMI 的匹配对照组，评估准入障碍措施对药物连续性的影响； (4) 评估这些准入障碍措施对护理结果的影响，包括基于利用的指标（心理健康住院、危机护理）、自我报告（症状控制、生活质量、满意度）、死亡率和护理费用通过分析双重资格者之间的差异，并将双重资格 SMI 与仅医疗补助受益人的匹配组进行比较。为了评估短期和长期影响，将分析实施后四年半的时间。基于管理数据的分析将得到分析的补充，这些分析纳入了对 450 名双重资格样本和 150 名仅享受医疗补助的 SMI 进行倾向评分匹配的样本进行现场访谈的数据。访谈将于 2010 年初进行，并提供有关护理结果的自我报告信息（药物连续性、症状水平和生活质量）。还将获得行政数据中无法获得的协变量（例如生活状况）以及与个人决定改变其 D 部分计划注册相关的因素和过程的访谈数据。与马里兰州精神卫生管理局合作进行的拟议研究的结果将提供针对双重资格 SMI 人群的特定信息，这些信息与政策制定者、医疗保险和医疗补助管理者、D 部分药房计划、提供者和倡导者相关。患有精神疾病的人。