计划类型和综合药物审查对高风险药物使用的影响。
The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use.
机构信息
1 Ohio State University College of Pharmacy, Columbus.
2 University of Arizona College of Pharmacy, Tucson.
出版信息
J Manag Care Spec Pharm. 2018 May;24(5):416-422. doi: 10.18553/jmcp.2018.24.5.416.
BACKGROUND
In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers.
OBJECTIVE
To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use.
METHODS
This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures.
RESULTS
In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001).
CONCLUSIONS
This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries.
DISCLOSURES
No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.
背景
2007 年，医疗保险和医疗补助服务中心（CMS）实施了一项星级评级系统，使用绩效结果衡量标准来评估医疗保险优势处方药（MAPD）和处方药计划（PDP）提供者。
目的
评估医疗保险提供者的两种绩效结果衡量标准，即综合药物评估（CMR）和高风险药物使用之间的关系。
方法
这项横断面研究包括 2014 年和 2015 年的 Medicare 部分 C 和部分 D 绩效数据。从 CMS 按 Medicare 合同下载绩效数据。我们将医疗保险提供者的绩效数据与每个合同的参保数据相匹配。使用 Mann-Whitney U 和 Spearman rho 检验以及分层线性回归模型评估提供者特征、高风险药物使用与 CMR 完成率结果之间的关系。
结果
在 2014 年，MAPD 计划提供者中发现 CMR 完成率与高风险药物使用之间呈负相关关系。这种关系在 2015 年进一步加强。在这两年中，PDP 计划提供者的 CMR 完成率与高风险药物使用之间均未发现相关性。多元回归发现，与 PDP 计划提供者相比，2014 年（β=-0.358，P<0.001）和 2015 年（β=-0.350，P<0.001）MAPD 计划提供者中高风险药物使用与 CMR 完成率呈负相关，2015 年 CMR 完成率（β=-0.221，P<0.001）和参保人数（β=-0.203，P=0.001）呈负相关。
结论
本研究发现，MAPD 计划提供者和更高的 CMR 完成率与受益人的高风险药物使用量降低相关。
披露
本研究无外部资金支持。Silva Almodovar 报告在本研究期间，他获得了来自亚利桑那州图森的 SinfoniaRx 的奖学金。其他作者没有需要披露的内容。
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