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

描述(由申请人提供)：这项研究将基于对18-60岁、残疾和双重符合条件的严重精神病患者(SMI)的管理数据(联邦医疗补助和联邦医疗保险)的分析，研究联邦医疗保险D部分(2006年1月1日实施)对药物变化、药物的连续性、利用率、成本和患者报告的结果的影响。他们的经历和结果将与马里兰州仅继续接受医疗补助的SMI患者的倾向得分匹配的组进行比较。具体目标是：(1)制定一套考虑到D部分计划条款(处方结构、阶梯式治疗、共同支付水平、数量限制和事先授权要求)的个人层面的准入障碍措施，这些措施可以限制获得药物的机会，并可用作SMI患者转换D部分计划的预测指标；(2)检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)使用双重符合条件者之间的差异以及D部分实施前后的经验以及保留医疗补助药物覆盖范围的SMI的匹配对照组的数据，评估获得障碍措施对药物连续性的影响；以及(4)通过分析双重符合条件者之间的差异，并通过将双重符合条件的SMI与匹配的仅符合医疗补助的受益者组进行比较，评估这些获得障碍措施对护理结果的影响，包括基于利用的指标(精神健康住院、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。为了评估短期和长期影响，将分析实施后四年半的时间。基于行政数据的分析将得到分析的补充，这些分析纳入了450名符合双重条件的样本和150名仅接受医疗补助的SMI的倾向得分匹配组的面对面访谈数据。访谈将于2010年初进行，并将提供关于护理结果(用药连续性、症状水平和生活质量)的自我报告信息。还将获得关于行政数据中没有的协变量(例如，生活状况)以及与个人决定改变其D部分计划投保计划有关的因素和程序的访谈数据。这项拟议的研究是与马里兰州精神卫生管理局合作进行的，研究结果将提供与政策制定者、联邦医疗保险和医疗补助管理人员、D部分药房计划、提供者和精神病患者倡导者相关的特定于双重资格的SMI人群的信息。

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.