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

描述（由申请人提供）：该研究将检查医疗保险D部分（2006年1月1日实施）对药物、药物连续性、利用、成本和患者报告结果的影响，该影响基于对行政数据（医疗补助和医疗保险）的分析，对象是患有严重精神疾病（SMI）、18-60岁、残疾和双重资格的人。他们的经历和结果将与一组倾向得分匹配的重度精神障碍患者进行比较，这些患者只在马里兰州接受医疗补助。具体目标是：(1)制定一套个人层面的获取障碍措施，考虑到D部分计划规定（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），这些规定可以限制药物的获取，并可作为重度精神障碍患者D部分计划切换的预测因素；(2)检查这些获取障碍措施与个人受益人计划切换之间的关系；(3)评估准入障碍措施对药物连续性的影响，使用双资格者之间的差异数据，以及D部分实施前后的经验，以及保留医疗补助药物覆盖的重度精神障碍患者的匹配对照组；(4)评估这些准入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）、死亡率和护理成本，通过分析双重符合条件的SMI之间的差异，并通过将双重符合条件的SMI与匹配的医疗补助受益人组进行比较。为了评估短期和长期效果，将分析实施后4年半的时间。以行政数据为基础的分析将辅以对450名双重合格样本和150名只接受医疗补助的重度精神病患者倾向分数匹配组的面对面访谈数据的分析。访谈将于2010年初进行，并将提供关于护理结果（药物连续性、症状水平和生活质量）的自我报告信息。访谈数据还将获得行政数据中没有的协变量（例如，生活状况）以及与个人决定转换其D部分计划登记有关的因素和过程。拟议研究的结果是与马里兰州精神卫生管理局合作进行的，将为双重符合条件的重度精神障碍人群提供具体的信息，这些信息与政策制定者、医疗保险和医疗补助管理人员、D部分药房计划、提供者和精神疾病患者的倡导者有关。

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.