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）影响了大约77%的老年社区居民医疗保险人口，是该群体住院、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医疗保险人群所需药物的可及性，但对心血管疾病患者的具体影响尚不清楚，特别是在药物依从性、卫生服务使用和患者预后方面。此外，在D部分实施后的八年内，老年CVD医疗保险参保者中这些结果的主要趋势尚不清楚。采用强准实验方法和具有全国代表性的医疗保险受益人调查（2000-2013），我们将确定14年期间患有心血管疾病的老年医疗保险患者人群，并评估其使用和临床结果的近期和长期变化。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，与成本相关的药物不依从性，急性医院事件，感知健康状况。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，包括患者成本应对策略、每月遵守规定和计划外采购。对于高危CVD患者（那些药物支出接近或高于D部分“甜甜圈洞”覆盖缺口阈值的患者），我们将估计2011年品牌药物覆盖率突然改善后在该覆盖缺口内的结果变化。特别是，我们将根据治疗药物类别和品牌与仿制药状态，检查处于或接近覆盖缺口的D部分患者的依从性和CVD治疗强度的变化。

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.