Prescription Drug Coverage and Health Outcomes in Elders

描述（由申请人提供）：Jennifer Tjia博士是宾夕法尼亚大学的老年医学研究员，致力于老年健康服务研究。Tjia博士的目标是开发一个多学科的研究项目，以（1）了解州和联邦处方药政策对老年人健康结果和卫生服务使用的影响，（2）了解老年人药物摄入和依从性的预测因素。这个指导临床科学家职业发展奖将提供实现这一目标的两个重要步骤的手段。首先，它将允许在公共政策研究，卫生经济学和高级统计学方面进行额外的强化指导教育和培训，这将加强以前在流行病学，生物统计学和临床医学方面的严格培训。其次，它将支持开发一个原始的临床研究计划，使用严格的流行病学和计量经济学方法来检查处方药覆盖范围对健康结果的影响。 由于新的处方药有助于医疗保健成本的上升和改善健康的承诺，重要的是要了解处方药保险如何影响老年人的健康和医疗服务的利用。虽然一些政策制定者认为，提供药房福利可以通过减少卫生服务的利用和改善健康来降低成本，但缺乏支持这一主张的证据。 候选人在国家和州一级提出了两项补充研究，以解决老年人获得药物的重要而未回答的问题。研究一是一项国家级的观察性队列研究，使用医疗保险当前受益调查（MCBS）的数据来检查药物覆盖对不良事件发生率和药物持续性的影响。研究二是一项健康政策自然实验，使用北卡罗来纳州医疗补助要求来衡量新药福利计划对不良事件和州医疗保健支出的影响。这个由两部分组成的研究计划将对理解处方药政策对老年人健康结果的影响的核心问题的关系进行三角测量，并为候选人过渡到老年健康服务研究的独立调查员奠定基础。

DESCRIPTION (provided by applicant): Dr. Jennifer Tjia, a Geriatrics Fellow at the University of Pennsylvania, is dedicated to a career in Geriatric Health Services Research. Dr. Tjia's goal is to develop a multidisciplinary research program to (1) understand the effect of state & federal prescription drug policies on elder health outcomes and health service use and (2) understand the predictors of medication uptake and adherence among older adults. This Mentored Clinical Scientist Career Development Award will provide the means to take two important steps toward this goal. First, it will allow for additional intensive mentored education and training in public policy research, health economics, and advanced statistics that will augment previous rigorous training in epidemiology, biostatistics, and clinical medicine. Second, it will support the development of an original clinical research program using rigorous epidemiologic and econometric methods to examine the impact of prescription drug coverage on health outcomes. As new prescription drugs contribute to rising health care costs and the promise of improved health, it is important to understand how prescription drug insurance affects the health and medical service utilization of older adults. Although some policymakers argue that the provision of a pharmacy benefit may reduce costs through reduced health service utilization and improved health, evidence to support this assertion is lacking. The candidate proposes two complementary studies at both the national and state levels to address the important, unanswered questions about medication access by older adults. Study One is a national-level observational cohort study using data from the Medicare Current Beneficiary Survey (MCBS) to examine the effect of drug coverage on the incidence of adverse events and medication persistence. Study Two is a health policy natural experiment using North Carolina Medicaid claims to measure the effect of a new drug benefit program on adverse events and state health care expenditures. This two-part research program will triangulate on the nexus of issues central to understanding the effect of prescription drug policy on elder health outcomes and form the foundation for the candidate's transition to an independent investigator in Geriatric Health Services Research.