B-blocker Compliance Post-MI: Costs, Causes, Disparities

MI 后 B 受体阻滞剂合规性：成本、原因、差异

• 批准号: 7118111
• 负责人: WILLIAM B. VOGT
• 金额: $ 5.05万
• 依托单位: CARNEGIE-MELLON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7118111
• 关键词: age difference; behavioral /social science research tag; beta antiadrenergic agent; clinical research; gender difference; geographic difference; health care cost /financing; health care service utilization; health disparity; health insurance; health services research tag; heart disorder chemotherapy; human data; human mortality; human subject; myocardial infarction; patient care personnel relations; physicians; racial /ethnic difference; therapy compliance

Heart disease is the leading cause of death among Americans 65 and older and the second leading cause of death in the 45-64 age group. A substantial fraction of these deaths are due to acute myocardial infarction. Long-term beta blocker therapy after AMI is a proven method for reducing mortality, cardiovascular mortality, and repeat AMI. Short-term compliance with beta-blocker therapy is good and improving, but recent studies show that in the year after AMI compliance with beta-blocker therapy drops sharply: half or fewer of patients are compliant at one year post-AMI. Furthermore, little is known about the causes or consequences of this decline. Given the widespread age, sex, and racial disparities in treatment and outcome for heart disease, disparities in compliance may be particularly salient. In an observational, retrospective setting using claims data from a large health insurer, therefore, we aim to: 1) measure the difference in healthcare costs between patients compliant and non-compliant with long-term beta-blocker therapy post-AMI. 2) measure disparities in compliance based upon age, sex, race, income, and insurance status. 3) measure how compliance varies with the characteristics of a patient's physician and with the characteristics of the physician-patient interaction. 4) decompose the variation in compliance into physician-specific and patient-specific components. 5) measure differences in mortality, reinfarction, and readmission between compliant and non-compliant patients, in order to assess selection bias in our data.

心脏病是 65 岁及以上美国人的首要死因，也是 45-64 岁年龄段的第二大死因。这些死亡中很大一部分是由于急性心肌梗死造成的。 AMI 后长期 β 受体阻滞剂治疗是一种行之有效的降低死亡率、心血管死亡率和重复 AMI 的方法。 β 受体阻滞剂治疗的短期依从性良好且正在改善，但最近的研究表明，在 AMI 发生后一年，对 β 受体阻滞剂治疗的依从性急剧下降：一半或更少的患者在 AMI 发生后一年仍能依从。此外，人们对这种下降的原因或后果知之甚少。鉴于心脏病治疗和结果方面存在广泛的年龄、性别和种族差异，依从性的差异可能尤其突出。因此，在使用大型健康保险公司索赔数据的观察性、回顾性环境中，我们的目标是：1) 衡量 AMI 后遵守和不遵守长期 β 受体阻滞剂治疗的患者之间的医疗费用差异。 2) 根据年龄、性别、种族、收入和保险状况衡量合规性差异。 3) 衡量依从性如何随患者医生的特征以及医患互动的特征而变化。 4) 将依从性的变化分解为医生特定和患者特定的部分。 5）测量依从性和不依从性患者之间死亡率、再梗塞和再入院的差异，以评估我们数据中的选择偏差。

项目成果

Beta-blocker compliance, mortality, and reinfarction: validation of clinical trial association using insurer claims data.

β-受体阻滞剂依从性、死亡率和再梗塞：使用保险公司索赔数据验证临床试验关联。

• DOI: 10.1177/1062860609345003
• 发表时间: 2009
• 期刊: American journal of medical quality : the official journal of the American College of Medical Quality
• 作者: Kleiner,SamuelA;Vogt,WilliamB;Gladowski,Patricia;DeVries,Andrea;Levin,Gary;Antonucci,Christopher;Fong,John
• 通讯作者: Fong,John