SMI Dual Eligibles and Medicare Part D: Impact on Medications Continuity and Outc

描述（由申请人提供）：本研究将根据对严重精神疾病（SMI）、年龄18-60岁、残疾和双重资格患者的管理数据（医疗补助和医疗保险）的分析，检查医疗保险D部分（2006年1月1日实施）对药物变化、药物连续性、利用率、成本和患者报告结局的影响。他们的经验和结果将与马里兰州仅接受医疗补助的SMI患者的倾向评分匹配组进行比较。具体目标是：（1）制定一套考虑到D部分计划规定的个人出入障碍措施（处方结构、阶梯式治疗、共同负担水平、数量限制和事先授权要求），这些因素可能限制药物的获取，并且可用作重度精神障碍患者D部分计划转换的预测因素;（2）审查这些准入障碍措施与个别受益人改变计划之间的关系;（3）使用双重-死亡率以及D部分实施前后的经验和保留Medicaid药物覆盖的SMI匹配对照组;以及（4）评估这些获取障碍措施对护理结果的影响，包括基于利用率的指标（精神卫生住院，危机护理），自我报告（症状控制，生活质量，满意度），死亡率和护理费用，通过分析双杀之间的变化，并通过比较双重合格的SMI与匹配组的医疗补助的唯一受益人。为了评估短期和长期影响，将对实施后四年半的时间进行分析。基于管理数据的分析将通过合并450例双重合格样本和150例仅接受医疗补助的SMI的倾向评分匹配组的面对面访谈数据的分析进行补充。访谈将于2010年初进行，并将提供有关护理结果（药物连续性，症状水平和生活质量）的自我报告信息。还将获得行政数据中不可用的协变量的访谈数据（例如，生活状况）以及与个人决定转换其Part D计划入组相关的因素和过程。与马里兰州精神卫生管理局合作进行的拟议研究的结果将提供与政策制定者，医疗保险和医疗补助管理人员，D部分药房计划，提供者和精神疾病患者倡导者相关的双重合格SMI人群的特定信息。

DESCRIPTION (provided by applicant): The study will examine the impact of Medicare Part D (implemented January 1, 2006) on changes in medications, medications continuity, utilization, cost, and patient-reported outcomes based on an analysis of administrative data (Medicaid and Medicare) for persons with severe mental illnesses (SMI), ages 18-60, disabled, and dually eligible. Their experience and outcomes will be compared with a propensity-score matched group of SMI persons remaining on Medicaid only, in Maryland. The specific aims are to: (1) Develop a set of individual-level access barrier measures that take account of Part D plan provisions (formulary structure, stepped therapy, copayment levels, quantity limits, and prior authorization requirements) that can restrict access to medications, and that can be used as predictors of Part D plan switching for persons with SMI; (2) Examine the relationship between these measures of access barriers and plan switching by individual beneficiaries; (3) Assess the impact of access barrier measures on medications continuity using data on variations among dual-eligibles as well as pre vs. post Part D implementation experience and the matched comparison group of SMI who retained Medicaid drug coverage; and (4) Assess the impact of these access barrier measures on outcomes of care including utilization-based indicators (mental health hospitalization, crisis care), self-report (symptom control, quality of life, satisfaction), mortality, and costs of care by analyzing variations among dual eligibles, and by comparing the dually eligible SMI with the matched group of Medicaid only beneficiaries. To assess short term and longer term effects, a four and a half year post implementation period will be analyzed. Analyses based on administrative data will be supplemented by analyses that incorporate data from in-person interviews of a sample of 450 dually eligible and a propensity-score matched group of 150 Medicaid-only SMI. The interviews will be conducted in early 2010 and will provide self-reported information on outcomes of care (medication continuity, symptom levels, and quality of life). Interview data will also be obtained on covariates not available in administrative data (e.g., living situation) and on factors and processes relating to individuals' decisions to switch their Part D plan enrollment. The findings from the proposed study, being undertaken in collaboration with the Maryland Mental Hygiene Administration, will provide information specific to dually eligible SMI populations that is relevant to policy-makers, Medicare and Medicaid administrators, Part D pharmacy plans, providers, and advocates for persons with mental illness.