Use of High-Risk Medications Among Older Adults Enrolled in Medicare Advantage Plans vs Traditional Medicare.
Use of High-Risk Medications Among Older Adults Enrolled in Medicare Advantage Plans vs Traditional Medicare.
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DOI：
10.1001/jamanetworkopen.2023.20583
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Frakt, Austin B.
中科院分区：
文献类型：
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作者：
Figueroa, Jose F.;Dai, Dannie;Feyman, Yevgeniy;Garrido, Melissa M.;Tsai, Thomas C.;Orav, E. John;Frakt, Austin B.
这项队列研究评估了传统 Medicare 与 Medicare Advantage D 部分计划的老年人的高风险药物处方配药率、随时间的变化以及与这些比率相关的患者层面因素。参加 Medicare Advantage 的老年 Medicare 受益人与传统按服务收费 Medicare D 部分计划相比，在使用高风险药物 (HRM) 方面是否存在显着差异？在这项包含 13-704-348 对受益人年份的队列研究中，与传统 Medicare 相比，参加 Medicare Advantage 计划的人的 HRM 调整后填充率较低，并且 2013 年至 2018 年间两种保险类型之间的比率差异缩小。与其他少数族裔相比，女性、美洲印第安人或阿拉斯加原住民以及非西班牙裔白人对 HRM 的使用率最高组。这项研究的结果表明，老年医疗保险受益人中参加医疗保险优势计划与较低的人力资源管理填写率之间存在关联，尽管存在差异，特别是在女性、美洲印第安人或阿拉斯加原住民和白人群体中。限制老年人使用高风险药物 (HRM) 是为 Medicare Advantage 和传统按服务付费 Medicare D 部分计划的老年受益人提供高质量护理的国家优先事项。旨在评估传统 Medicare 与 Medicare Advantage D 部分计划受益人的 HRM 处方配药率差异，并检查这些差异随时间变化的程度以及与较高 HRM 配药率相关的患者层面因素。该队列研究使用了 2013 年至 2017 年已配药处方的 Medicare D 部分数据的 20% 样本和 2018 年的 40% 样本。样本包括参加 Medicare Advantage 或传统 Medicare D 部分计划的 66 岁或以上的 Medicare 受益人。对 2022 年 4 月 1 日至 2023 年 4 月 15 日期间的数据进行了分析。主要结果是每 1000 名受益人中为老年医疗保险受益人开具的独特 HRM 数量。使用线性回归模型对主要结果进行建模，调整患者特征和县特征，并包括医院转诊区域固定效应。该样本包括 5 595 361 名独特的 Medicare Advantage 受益人，他们在 2013 年至 2018 年间逐年进行倾向得分匹配，与 6 578 126 名独特的传统 Medicare 受益人相匹配，从而产生 13 704 348 匹配的受益年份对。传统 Medicare 与 Medicare Advantage 队列在年龄（平均 [SD] 年龄，75.65 [7.53] 岁 vs 75.60 [7.38] 岁）、男性比例（8 127 261 [59.3%] vs 8 137 834 [59.4%]）方面相似；标准化平均差 [SMD] = 0.002），以及主要种族和民族（77.1% vs 77.4%） 非西班牙裔白人； SMD = 0.05）。 2013 年，Medicare Advantage 受益人平均每 1000 名受益人填写了 135.1 个（95% CI，128.4-142.6）个独特的 HRM，而传统 Medicare 每 1000 个受益人则填写了 165.6 个（95% CI，158.1-172.3）个 HRM。 2018 年，Medicare Advantage 中的 HRM 率降至每 1000 名受益人 41.5 个（95% CI，38.2-44.2）个 HRM，传统 Medicare 中的 HRM 率降至每 1000 名受益人 56.9 个（95% CI，54.1-60.1）个 HRM。在整个研究期间，与传统 Medicare 受益人相比，Medicare Advantage 受益人每年每 1000 名受益人收到的 HRM 减少了 24.3（95% CI，20.2-28.3）。女性、美洲印第安人或阿拉斯加原住民以及白人比其他群体更有可能接受 HRM。这项研究的结果表明，医疗保险优惠计划中的人力资源管理率始终低于传统医疗保险受益人。女性、美洲印第安人或阿拉斯加原住民以及白人中人力资源管理的使用率较高，这是一个令人担忧的差异，需要进一步关注。
This cohort study evaluates the rate of high-risk medication prescription fills, changes over time, and patient-level factors associated with these rates among older adults with traditional Medicare vs Medicare Advantage Part D plans. Are there meaningful differences in the use of high-risk medications (HRMs) among older Medicare beneficiaries enrolled in Medicare Advantage vs traditional fee-for-service Medicare Part D plans? In this cohort study of 13 704 348 matched pairs of beneficiary-years, lower adjusted rates of filled HRMs were found among those enrolled in Medicare Advantage plans compared with traditional Medicare, and the difference in rates between the 2 insurance types narrowed between 2013 and 2018. Female, American Indian or Alaska Native, and non-Hispanic White populations had the highest use of HRMs compared with other minority groups. Findings of this study suggest an association between enrollment in Medicare Advantage plans and lower rates of filled HRMs among older Medicare beneficiaries, although concerning disparities exist, particularly in female, American Indian or Alaska Native, and White populations. Limiting the use of high-risk medications (HRMs) among older adults is a national priority to provide a high quality of care for older beneficiaries of both Medicare Advantage and traditional fee-for-service Medicare Part D plans. To evaluate the differences in the rate of HRM prescription fills among beneficiaries of traditional Medicare vs Medicare Advantage Part D plans and to examine the extent to which these differences change over time and the patient-level factors associated with higher rates of HRMs. This cohort study used a 20% sample of Medicare Part D data on filled drug prescriptions from 2013 to 2017 and a 40% sample from 2018. The sample comprised Medicare beneficiaries aged 66 years or older who were enrolled in Medicare Advantage or traditional Medicare Part D plans. Data were analyzed between April 1, 2022, and April 15, 2023. The primary outcome was the number of unique HRMs prescribed to older Medicare beneficiaries per 1000 beneficiaries. Linear regression models were used to model the primary outcome, adjusting for patient characteristics and county characteristics and including hospital referral region fixed effects. The sample included 5 595 361 unique Medicare Advantage beneficiaries who were propensity score–matched on a year-by-year basis to 6 578 126 unique traditional Medicare beneficiaries between 2013 and 2018, resulting in 13 704 348 matched pairs of beneficiary-years. The traditional Medicare vs Medicare Advantage cohorts were similar in age (mean [SD] age, 75.65 [7.53] years vs 75.60 [7.38] years), proportion of males (8 127 261 [59.3%] vs 8 137 834 [59.4%]; standardized mean difference [SMD] = 0.002), and predominant race and ethnicity (77.1% vs 77.4% non-Hispanic White; SMD = 0.05). On average in 2013, Medicare Advantage beneficiaries filled 135.1 (95% CI, 128.4-142.6) unique HRMs per 1000 beneficiaries compared with 165.6 (95% CI, 158.1-172.3) HRMs per 1000 beneficiaries for traditional Medicare. In 2018, the rate of HRMs had decreased to 41.5 (95% CI, 38.2-44.2) HRMs per 1000 beneficiaries in Medicare Advantage and to 56.9 (95% CI, 54.1-60.1) HRMs per 1000 beneficiaries in traditional Medicare. Across the study period, Medicare Advantage beneficiaries received 24.3 (95% CI, 20.2-28.3) fewer HRMs per 1000 beneficiaries per year compared with traditional Medicare beneficiaries. Female, American Indian or Alaska Native, and White populations were more likely to receive HRMs than other groups. Results of this study showed that HRM rates were consistently lower among Medicare Advantage than traditional Medicare beneficiaries. Higher use of HRMs among female, American Indian or Alaska Native, and White populations is a concerning disparity that requires further attention.
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DOI：
10.11909/j.issn.1671-5411.2016.01.019
发表时间：
2016-01
期刊：
Journal of geriatric cardiology : JGC
影响因子：
--
作者：
Bell SP;Patel N;Patel N;Sonani R;Badheka A;Forman DE
通讯作者：
Forman DE
影响因子：
12.7
作者：
Kennedy, Jae;Wood, Elizabeth Geneva
通讯作者：
Wood, Elizabeth Geneva
影响因子：
9.7
作者：
Elliott, Marc N.;Landon, Bruce E.;Cleary, Paul D.
通讯作者：
Cleary, Paul D.
影响因子：
4.6
作者：
Lin, Chih-Wan;Wen, Yu-Wen;Hsiao, Fei-Yuan
通讯作者：
Hsiao, Fei-Yuan
影响因子：
5.7
作者：
Bao, Yuhua;Shao, Huibo;Bruce, Martha L.
通讯作者：
Bruce, Martha L.