权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

The Safety and Effectiveness of Diabetes Quality Metrics in Elderly Patients

老年患者糖尿病质量指标的安全性和有效性

基本信息

批准号：
8893638
负责人：
Julie A Schmittdiel
金额：
$ 27.65万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8893638
关键词：
Adherence Admission activity Adverse event Age Antihypertensive Agents Antilipemic Agents Automobile Driving Biometry Blood Pressure California Cardiovascular Diseases Cardiovascular system Caring Chronic Chronic Disease Client satisfaction Clinical Clinical Trials Clinical effectiveness Colorado Comorbidity Complex Data Data Analyses Data Sources Diabetes Mellitus Disease Outcome Effectiveness Elderly Emergency department visit Enrollment Event Foundations Goals Guideline Adherence Guidelines Health Planning Health Policy Healthcare Systems Hospitalization Hypoglycemia Hypoglycemic Agents Hypotension Incentives Influentials Integrated Delivery Systems Lead Link Measurement Measures Medicare Medicine Methods Monitor Oral Outcome Patients Performance Pharmaceutical Preparations Pharmacoepidemiology Policies Policy Maker Population Population Study Prevention Qualifying Quality of Care Quality of life Research Risk Factors Risk Reduction Safety Series Skilled Nursing Facilities Specific qualifier value Stroke United States Centers for Medicare and Medicaid Services Vulnerable Populations adverse outcome base beneficiary cardiovascular disorder risk clinical care clinical risk comparative effectiveness compare effectiveness design effectiveness research experience financial incentive health care quality health care service utilization improved innovation medication compliance meetings older patient patient oriented programs public health relevance treatment effect

项目摘要

DESCRIPTION (provided by applicant): Improving health care quality for seniors with diabetes is a critical issue for clinicians, health care systems, and policy-makers. The Medicare STAR program is the primary way in which the Center for Medicare & Medicaid Services (CMS) monitors quality of care for seniors with diabetes in health plans caring for Medicare enrollees. CMS attaches significant monetary incentives to these Medicare STAR measures for health plans, distributing millions of dollars to plans annually based on STAR results. A recent change in CMS policy introduced 3 new diabetes-relevant metrics to the Medicare STAR portfolio in 2012: adherence to oral antihyperglycemic, antihyperlipidemic, and antihypertensive medications. Current guidelines apply these metrics to all Medicare beneficiaries older than 18, with no upper age limit and no adjustment for the number or type of comorbidities patients experience. Quality metrics for patients with chronic illness are generally based on clinical tria evidence of reduced risk for clinical outcomes like cardiovascular events or stroke, and are conducted in younger study populations with few or no comorbidities. These data may not be generalizable or even appropriate for elderly patients, who often have multiple concurrent conditions and who may place a higher value on maintaining quality of life. Whether the CMS-defined adherence measures are sufficiently linked to CVD risk factor control outcomes for elderly diabetes patients, especially those with multiple comorbidities, is unknown. In addition, when applied to complex and elderly patients, quality metrics designed to increase medication adherence may increase adverse outcomes such as hypoglycemia and hypotension that reduce quality of life. The objective of this application is to leverage a secondary data source of over 120,000 diabetes patients over the age of 65 to assess how adherence to diabetes oral medications, statins, and blood pressure medications impact safety and outcomes for Medicare patients with diabetes, and to examine how these effects are influenced by the presence of key comorbidities. The specific aims of this research are to examine the impact of advanced age and specific comorbidities on meeting defined levels of adherence to CVD risk factor medications in diabetes patients; to compare the effectiveness of meeting adherence targets on CVD risk factor control, adverse events, and health care utilization; and to disseminate the study's findings to a wide range of clinical, operational, and policy stakeholders. This study will help lay a strong foundation for developing patient-centered diabetes quality metrics for the nation's growing Medicare population.

描述(由申请人提供)：提高老年糖尿病患者的医疗质量是临床医生、医疗保健系统和政策制定者面临的一个关键问题。Medicare STAR计划是Medicare&Medicaid Services(CMS)在照顾Medicare参保人的健康计划中监控患有糖尿病的老年人的护理质量的主要方式。CMS对这些Medicare STAR医疗计划措施给予了重大的金钱激励，每年根据STAR结果向计划分配数百万美元。CMS政策最近的变化在2012年为Medicare STAR产品组合引入了3项与糖尿病相关的新指标：坚持口服降糖、降血脂和降压药物。目前的指南将这些指标应用于所有18岁以上的联邦医疗保险受益人，没有年龄上限，也没有对患者合并疾病的数量或类型进行调整。慢性病患者的质量指标通常基于临床试验证据，证明心血管事件或中风等临床结果的风险降低，并在较年轻的研究人群中进行，很少或没有共病。这些数据可能不能推广，甚至不适合老年患者，他们经常有多种并发疾病，可能对维持生活质量有更高的重视。CMS定义的依从性措施是否与老年糖尿病患者，特别是那些合并多种疾病的老年糖尿病患者的心血管风险因素控制结果有足够的联系尚不清楚。此外，当应用于复杂的老年患者时，旨在提高服药依从性的质量指标可能会增加降低生活质量的不良后果，如低血糖和低血压。该应用程序的目标是利用超过12万名65岁以上糖尿病患者的次要数据来源，评估坚持服用糖尿病口服药物、他汀类药物和降压药如何影响患有糖尿病的联邦医疗保险患者的安全性和结局，并检查关键并存的存在如何影响这些影响。这项研究的具体目的是检查高龄和特定的合并症对糖尿病患者达到规定的心血管危险因素药物依从性水平的影响；比较在心血管危险因素控制、不良事件和卫生保健利用方面达到坚持目标的有效性；并将研究结果传播给广泛的临床、操作和政策利益相关者。这项研究将帮助为全国不断增长的医疗保险人口制定以患者为中心的糖尿病质量指标奠定坚实的基础。