Tanslating Research into Action for Diabetes (TRIAD) Legacy Study

项目描述：将糖尿病研究转化为行动(TRIAD)遗产研究的目标是检查与糖尿病患者的长期护理过程、发病率、成本和死亡率相关的系统和患者层面的因素。为了实现这一目标，这份遗产研究申请书提出了五个具体目标。第一个目标将从2001年招募的多地点三合会队列生成两份报告，其余的目标将通过四份新报告扩展我们在三合会D部分医疗保险研究方面的工作，这些报告将分析最近从50个州获得的2007年索赔数据，这些数据来自全国最大的D部分福利提供者之一。我们的具体目标是：1)检查抑郁症和抑郁症药物使用不足与三合会人群的医疗费用和死亡率之间是否存在关联；2)使用居住在50个州的Medicare Advantage Part D(MAPD)受益者2007年的数据，检查糖尿病、痴呆症和抑郁症等慢性疾病在自付费用、缺口条目和药物依从性方面的作用；3)使用2007年收集的50个州MAPD受益者样本的数据，确定Medicare Part D计划通过仿制药和治疗替代可能节省的成本；4)检查邮购使用对D部分计划中最贫穷的糖尿病联邦医疗保险受益人的自付成本、总药物成本和用药依从性的影响；5)比较低收入限定(LIQ)受益人与商业计划和糖尿病患者的自付药物成本、总药物成本和坚持慢性药物治疗的情况。许多由加州大学洛杉矶分校的教职员工作为第一作者或资深作者的报告都专注于研究服务不足和/或糖尿病高危人群。在遗产研究期间，建议的6项分析将 继续强调福利设计、成本分担和抑郁症等并存疾病如何对最脆弱的糖尿病患者产生不成比例的影响。 Legacy研究的第二个目标是继续发展新兴的调查人员。为此，建议的团队将继续我们11年来成功指导和提升初级调查人员的记录，重点是女性和少数族裔调查人员，通过继续指导加州大学洛杉矶分校助理教授O.Kenrik Duru博士和最近加入我们团队并将在建议遗产期间继续与我们合作的疾控中心经济学家Rui Li博士，她将由我们的高级卫生经济学家Susan Ettner博士和加州大学洛杉矶分校翻译研究中心(TRC)首席研究员Carol Mangone博士指导。此外，我们预期会继续与其他三合会注册中心的调查人员保持辅导关系。最后，在三合会遗产阶段，我们期望全面参与督导及出版委员会的活动，这些活动对这项突破性研究的最后阶段取得成功至为重要。

DESCRIPTION OF THE PROJECT: The goal of the Translating Research into Action for Diabetes (TRIAD) legacy studies is to examine the system- and patient-level factors that are associated with long-term processes of care, morbidity, costs, and mortality of persons with diabetes. To address this goal this Legacy Study application proposes five specific aims. The first aim will generate two reports from the multi-site TRIAD cohort that was recruited in 2001 and the remaining aims will extend our work on the TRIAD Part D Medicare Study with 4 new reports that will analyze recently acquired 2007 claims data from 50 states from one of the largest providers of the Part D benefit in the nation. Our specific aims are: 1) To examine whether there is an association between depression and under-use of medications for depression with medical costs and mortality for persons in the TRIAD cohort; 2) To use 2007 data from Medicare Advantage Part D (MAPD) beneficiaries who reside in 50 states to examine the role of chronic medical conditions such as diabetes, dementia, and depression on out-of-pocket costs, gap entry and adherence to medications; 3) To determine the potential cost savings in the Medicare Part D program from generic and therapeutic substitution using data from a 50-state sample of MAPD beneficiaries collected in 2007; 4) To examine the impact of mail-order use on out-of-pocket costs, total medication costs, and medication adherence for the poorest Medicare beneficiaries with diabetes in the Part D program; 5) To compare the out-of-pocket medication costs, total drug costs, and adherence to chronic medications for beneficiaries in Low Income Qualifier (LIQ) versus commercial plans and for persons with diabetes. Many of the reports that either have UCLA faculty as first or senior author have focused on studying underserved and/or high risk populations with diabetes. During the Legacy Study, the 6 analyses proposed will continue to emphasize how benefit design, cost sharing, and co-morbidities such as depression may disproportionately affect the most vulnerable persons with diabetes. A second objective of the Legacy Study is to continue to develop emerging investigators. To this end, the proposed team will continue our 11-year track record of successful mentorship and advancement of junior investigators with a strong focus on women and minority investigators by continuing to mentor Dr. O. Kenrik Duru, Assistant Professor at UCLA, and Rui Li, Ph.D., an economist at the CDC who has recently joined our team and will continue to work with us during the proposed Legacy where she will be mentored by Dr. Susan Ettner, our senior health economist, and Dr. Carol Mangione, the principal investigator of the UCLA Translational Research Center (TRC). Additionally, we expect to continue our mentoring relationships with a number of investigators from the other TRIAD TRCs. Finally, during the TRIAD Legacy phase we expect to be full participants in the steering and publication committee activities that will be vital to the success of the final stage of this ground-breaking study.