Evaluating an Intervention to Improve Medication Access and Quality of Care for Underserved Populations With Chronic Conditions

评估改善服务不足的慢性病人群的药物获取和护理质量的干预措施

• 批准号: 10528287
• 负责人: Anna D Sinaiko
• 金额: $ 58.95万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-22 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10528287
• 关键词: Address; Affect; Ambulatory Care; Area; Asthma; Atrial Fibrillation; Attitude; Behavior; Belief; Black Populations; Black race; COVID-19 pandemic; Caring; Characteristics; Chronic; Chronic Disease; Clinical; Colorado; Data; Data Set; Diabetes Mellitus; Discrimination; Disease; Electronic Health Record; Ethnic Origin; Focus Groups; Frequencies; Goals; Guidelines; Health; Health Status; Health system; Healthcare Systems; Hispanic; Hispanic Populations; Household; Improve Access; Income; Intervention; Interview; Language; Latino; Latino Population; Learning; Link; Measures; Medical; Medicare; Mental Depression; Morbidity - disease rate; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Policies; Population; Population Decreases; Provider; Quality of Care; Race; Registries; Research; Residencies; Resources; Rural; Rural Population; Sampling; Site; Structural Racism; System; Telemedicine; Time; Travel; Trust; Underserved Population; Universities; Variant; acute care; care episode; clinical encounter; cost; cost estimate; data registry; data tools; demographics; design; ethnic minority population; evidence base; evidence based guidelines; experience; health disparity; health literacy; implementation strategy; implementation tool; improved; longitudinal dataset; mortality; novel; patient population; practice factors; preference; racial and ethnic; rural area; rural patients; rural residence; tool; treatment choice; treatment services

Underuse of evidence-based medications for chronic disease, driven in part by high out-of-pocket (OOP) medication costs, accounts for substantial preventable morbidity and mortality due to exacerbation of chronic illnesses. This underuse, and the resultant adverse health outcomes, are worse for patients who are Black, Hispanic, or Latino, and those who live in rural areas. Addressing gaps in cost information may reduce OOP spending and improve underuse. Sometimes clinicians prescribe more expensive agents when less costly, equally effective medications exist, in part because, until recently, they lacked information regarding what patients must pay for a particular drug. OOP cost information could also help patients and clinicians make treatment choices that are consistent with patient preferences and goals. In 2019, the University of Colorado Health System (UCHealth) implemented in all ambulatory care sites a Real-Time Benefit Tool (RTBT) that shows clinicians a patient’s OOP medication costs—the cost the patient would pay at a pharmacy—in the Electronic Health Record. Medicare policy supports RTBTs and will increase its implementation. Because cost- related medication underuse is significant among racial/ethnic minority and rural populations, a RTBT has the potential to increase guideline-concordant care in these populations and decrease disparities. On the other hand, use of RTBT may be less frequent among populations with chronic conditions who are Black, Hispanic, Latino, or in rural areas due to differences in where care is received (e.g. telemedicine), health literacy and language, cultural identity and norms, medical system behaviors that erode trust, or interpersonal and structural racism within the health care system. The project will focus on patients with asthma, atrial fibrillation, diabetes, or depression—common chronic conditions for which there are both costly and low-cost clinically effective drugs—and measure (1) outcomes among patients who are Black, Hispanic, or Latino, or who live in rural areas and (2) how these outcomes differ compared with other patients with the same chronic conditions. We will use unique UCHealth data linking clinical medication orders, pharmacy claims, patient data (including race, ethnicity, other demographics, and health status), and RTBT data to assess variation in RTBT use and whether the RTBT is associated with patients’ first medication fills. We will use the Colorado All-Payer Claims data and a difference-in-difference design to measure the impact of the RTBT on use of medications consistent with national evidence-based recommendations and on poor health outcomes. We will characterize via interviews and focus groups whether and how RTBT affects experiences, is consistent with patient preferences in their clinical encounters, and the factors associated with positive and negative experiences. This project will produce evidence on the policy impact of an RTBT on access and quality of care for Black, Hispanic, Latino, and rural patients with chronic conditions and on health disparities, and on implementation strategies to maximize impact.

慢性病循证药物使用不足，部分原因是自付费用（OOP）高 药物费用，占相当大的可预防的发病率和死亡率，由于慢性 疾病。这种使用不足，以及由此产生的不良健康后果，对黑人患者来说更糟， 西班牙裔，或拉丁美洲人，和那些谁住在农村地区。解决成本信息中的差距可能会减少OOP 支出和改善未充分利用。有时临床医生在便宜的时候开更贵的药， 同样有效的药物存在，部分原因是，直到最近，他们缺乏关于什么的信息， 病人必须为某种药物付费。OOP成本信息还可以帮助患者和临床医生 治疗选择符合患者的偏好和目标。2019年，科罗拉多大学 卫生系统（UCHealth）在所有门诊护理站点实施实时福利工具（RTBT）， 向临床医生显示患者的OOP药物费用-患者将在药店支付的费用-在 电子健康记录。医疗保险政策支持RTBT，并将增加其实施。因为成本- 相关药物使用不足在种族/少数民族和农村人口中很重要，RTBT具有 有可能增加这些人群的符合指南的护理并减少差异。另 另一方面，RTBT的使用可能不太频繁的人群与慢性疾病谁是黑人，西班牙裔， 拉丁美洲人，或农村地区，因为在哪里接受护理（如远程医疗），卫生知识和 语言、文化认同和规范、损害信任的医疗系统行为，或人际关系和 卫生保健系统中的结构性种族主义。该项目将重点关注哮喘、房颤、 糖尿病或抑郁症-常见的慢性疾病，临床上既有昂贵的，也有低成本的 有效的药物-并测量（1）黑人，西班牙裔或拉丁裔患者，或居住在 农村地区和（2）这些结果与其他患有相同慢性病的患者相比有何不同。 我们将使用独特的UCHealth数据链接临床药物订单，药房索赔，患者数据（包括 种族、民族、其他人口统计学和健康状况）和RTBT数据，以评估RTBT使用的变化， RTBT是否与患者的首次用药有关。我们将使用科罗拉多所有付款人索赔 数据和差异中的差异设计，以衡量RTBT对药物使用的影响， 国家循证建议和不良健康结果。我们将通过 访谈和焦点小组是否以及如何RTBT影响的经验，是符合病人的喜好 在他们的临床遭遇，以及与积极和消极的经验相关的因素。该项目将 提供RTBT对黑人，西班牙裔，拉丁裔， 和农村慢性病患者的健康差距以及 最大化影响。