Changes in Cardiovascular Care and Outcomes in Eight Years after Medicare Part D

描述(由申请人提供)：心血管疾病(CVD)影响着大约77%的老年社区医疗保险人口，是这一群体住院、死亡和医疗支出的最大驱动因素。自2006年以来，补贴的D部分药物福利改善了参加联邦医疗保险的人获得所需药物的机会，但对心血管疾病患者的具体影响尚不为人所知，特别是在服药依从性、卫生服务的使用和患者结果方面。此外，在D部分实施后的八年中，患有心血管疾病的老年医疗保险参与者的这些结果的主要趋势尚不清楚。使用强大的准实验方法和具有全国代表性的联邦医疗保险当前受益者调查(2000-2013)，我们将确定14年期间患有心血管疾病的老年联邦医疗保险患者的人口，并评估他们在D部分之后的利用和临床结果的即时和长期变化。研究措施将包括人口统计学和临床属性、药物和非药物使用、与成本相关的用药不遵守、急性医院事件和感知的健康状态。在D部分实施后的一段时间内，我们将制定和审查新的措施，包括患者成本应对战略、逐月坚持和计划外采购。对于高危心血管疾病患者(那些药物支出接近或超过D部分“甜甜圈洞”覆盖缺口阈值的患者)，我们将估计2011年品牌药物覆盖范围在该覆盖缺口内突然改善后的结果变化。特别是，我们将按治疗药物类别和品牌与仿制药状态检查D部分患者在覆盖差距或附近的依从性和心血管疾病治疗强度的变化。 公共卫生相关性：对于大量患有心血管疾病的老年人口来说，医疗保险D部分实施对获得药物的影响以及卫生服务和结果的变化知之甚少。我们的研究旨在调查这些重要结果在D部分实施后的8年内的变化，特别是在2011年进入“甜甜圈洞”覆盖缺口的患者的品牌药物大幅折扣之后。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) affects approximately 77% of the elderly, community-dwelling Medicare population and is the largest driver of hospital admissions, deaths, and health expenditures in this group. Since 2006, the subsidized Part D drug benefit has improved the accessibility of needed medications for people in Medicare, but the specific effects on those with CVD are not well-known, in particular in terms of medication adherence, use of health services, and patient outcomes. Moreover, nothing is known about major trends in these outcomes among elderly Medicare enrollees with CVD in the eight years following Part D implementation. Using strong quasi-experimental methods and the nationally-representative Medicare Current Beneficiary Survey (2000-2013), we will identify the population of elderly Medicare patients with CVD during a 14-year period and evaluate immediate and longer-term changes in their utilization and clinical outcomes following Part D. Study measures will include demographic and clinical attributes, drug and non-drug utilization, cost-related medication nonadherence, acute hospital events, and perceived health status. For the period after Part D implementation, we will develop and examine new measures including patient cost-coping strategies, month-to-month adherence, and out-of-plan purchasing. For high-risk CVD patients (those with drug spending near or above the Part D "donut hole" coverage gap threshold), we will estimate changes in outcomes following the sudden 2011 improvement in brand name drug coverage within this coverage gap. In particular, we will examine changes in adherence and CVD treatment intensity for Part D patients in or near the coverage gap, by therapeutic drug class and by brand versus generic status. PUBLIC HEALTH RELEVANCE: The effects of Medicare Part D implementation on access to medicines and changes in health services and outcomes are poorly understood for the large population of elderly with cardiovascular disease. Our study aims to investigate changes in these important outcomes in the 8 years following Part D implementation, in particular after a large 2011 discount on branded medicines for patients entering the "donut hole" coverage gap.