USC Schaeffer Center, VPD Suite 414, Los Angeles, CA 90087. Email:
Am J Manag Care. 2019 Feb;25(2):78-83.
To assess the extent to which medication adherence in congestive heart failure (CHF) and diabetes may serve as a measure of physician-level quality.
A retrospective analysis of Medicare data from 2007 to 2009, including parts A (inpatient), B (outpatient), and D (pharmacy).
For each disease, we assessed the correlation between medication adherence and health outcomes at the physician level. We controlled for selection bias by first regressing patient-level outcomes on a set of covariates including comorbid conditions, demographic attributes, and physician fixed effects. We then classified physicians into 3 levels of average patient medication adherence-low, medium, and high-and compared health outcomes across these groups.
There is a clear relationship between average medication adherence and patient health outcomes as measured at the physician level. Within the diabetes sample, among physicians with high average adherence and controlling for patient characteristics, 26.3 per 1000 patients had uncontrolled diabetes compared with 45.9 per 1000 patients among physicians with low average adherence. Within the CHF sample, also controlling for patient characteristics, the average rate of CHF emergency care usage among patients seen by physicians with low average adherence was 16.3% compared with 13.5% for doctors with high average adherence.
This study's results establish a physician-level correlation between improved medication adherence and improved health outcomes in the Medicare population. Our findings suggest that medication adherence could be a useful measure of physician quality, at least for chronic conditions for which prescription medications are an important component of treatment.
评估充血性心力衰竭 (CHF) 和糖尿病患者的药物依从性在多大程度上可以作为衡量医生水平的质量标准。
对 2007 年至 2009 年 Medicare 数据的回顾性分析，包括 A 部分（住院）、B 部分（门诊）和 D 部分（药房）。
对于每种疾病，我们评估了药物依从性与医生水平的健康结果之间的相关性。我们通过首先将患者水平的结果回归到一组协变量上，包括合并症、人口统计学属性和医生固定效应，来控制选择偏差。然后，我们将医生分为 3 个平均患者药物依从性水平-低、中、高-并比较这些组之间的健康结果。
在医生水平上，患者药物依从性与患者健康结果之间存在明显的关系。在糖尿病样本中，在控制患者特征的情况下，高平均依从性的医生中，每 1000 名患者中有 26.3 名患者未控制糖尿病，而低平均依从性的医生中，每 1000 名患者中有 45.9 名患者未控制糖尿病。在 CHF 样本中，同样控制患者特征，低平均依从性的医生的患者中，接受 CHF 急诊护理的平均使用率为 16.3%，而高平均依从性的医生为 13.5%。
这项研究的结果在 Medicare 人群中建立了药物依从性与健康结果改善之间的医生水平相关性。我们的研究结果表明，药物依从性可能是衡量医生质量的一个有用指标，至少对于需要处方药物作为治疗重要组成部分的慢性疾病来说是这样。
