EFFECTIVENESS OF RETROSPECTIVE DRUG UTILIZATION REVIEW

不适当的药物处方是一个重要的公共卫生 问题.因为老年人更有可能伴随着 疾病和药物，他们是最大的风险，不利的 成果。例如，一项针对老年人的研究发现， 28%的住院是由于药物问题， 显示医疗补助受助者的人数特别增加， 风险药物利用审查（DUR）是一个程序，旨在 减少不当处方的后果。部分原因是 联邦授权，追溯DUR现在正在应用于数百万人 美国老年人，包括所有医疗补助登记者和70- 有处方药保险的人的百分之五 尽管完全没有严格的证据表明 DUR在改变药物治疗或改善 健康成果。鉴于现有的联邦授权， 在医疗补助人群中进行DUR试验不可行。因此，我们认为， 一项及时的、对照良好的DUR有效性观察试验 非常需要。 宾夕法尼亚大学有一个独特的机会， 一项关于DUR对处方的影响的严格观察试验 模式和临床结果。使用大量独特的数据 来源，我们打算评估DUR对这两个过程的影响 测量和临床结果测量。我们使用的方法 建议纳入干预前后的比较， 并发控制。这将使我们能够衡量一些 DUR的重要影响，控制 国家计划和因果无关的世俗计划之间的差异 趋势我们打算采用三种不同的、互补的抽样方法 提出研究问题的框架。的学习问题 经过精心挑选，并解决实际问题， 理论重要性。 这项研究的结果，无论是积极的还是消极的， 广泛的卫生政策和科学影响，特别是 关于老年人。宾夕法尼亚大学有一个伟大的 在制药成果研究项目方面的大量经验， 特别是那些使用大型索赔数据库的人。的 调查人员将能够提供明确的，有意义的答案， 这项研究在很短的时间内提出问题，而且在很短的时间内提出问题。 成本效益的方式。

Improper prescribing of medications is an important public health problem. Because the aged are more likely to have concomitant illnesses and medications, they are at greatest risk for adverse outcomes. For example, one study conducted in the elderly found that 28% of hospital admissions were due to medication problems, and showed that Medicaid recipients were at an especially increased risk. Drug utilization review (DUR) is a procedure that seeks to reduce the consequences of improper prescribing. In part because of federal mandate, retrospective DUR is now being applied to millions of older Americans, including all Medicaid enrollees and seventy- five percent of all people with prescription insurance coverage. This is despite the complete absence of rigorous evidence indicating that DUR is effective in either altering drug therapy or improving health outcomes. Given the existing federal mandate, an experimental trial of DUR in the Medicaid population is infeasible. Therefore, a timely, well-controlled observational trial of DUR's effectiveness is badly needed. The University of Pennsylvania has a unique opportunity to conduct a rigorous observational trial of DUR's effects on prescribing patterns and on clinical outcomes. Using a large, unique data source, we intend to evaluate the effects of DUR on both process measures and clinical outcome measures. The methodology that we propose incorporates both pre-post intervention comparisons, and concurrent controls. This will enable us to measure a number of important effects of DUR, controlling for possible effects of differences between state programs and causally unrelated secular trends. We intend to employ three distinct, complementary sampling frames from which to pose the study questions. The study questions have been carefully selected, and address issues of practical and theoretical importance. The results of this study, whether positive or negative, will have wide-ranging health policy and scientific implications, especially with regard to the aged. The University of Pennsylvania has a great deal of experience in pharmaceutical outcomes research projects such as this, especially those using large claims databases. The investigators will be able to provide clear, meaningful answers to the study questions in a very short time-frame, and do so in a very cost-efficient manner.