Improving Medication Use and Outcomes in Older Adults with Dementia after Hospitalization: Effectiveness of Medicare Programs

改善老年痴呆症患者住院后的药物使用和结果：医疗保险计划的有效性

• 批准号: 10593952
• 负责人: Antoinette Bartolotta Coe
• 金额: $ 15.52万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593952
• 关键词: Adverse drug event; Adverse effects; Advisory Committees; Affect; Aftercare; Aging; Alzheimer' s disease related dementia; American; Award; Behavioral Model; Caregivers; Caring; Central Nervous System Agents; Clinical; Cognition; Data; Delirium; Dementia; Development Plans; Doctor of Pharmacy; Doctor of Philosophy; Drug Interactions; Education; Effectiveness; Elderly; Eligibility Determination; Emergency department visit; Ensure; Environment; Epidemiology; Exposure to; Female; Goals; Health; Health Policy; Health Services; Healthcare; Hospitalization; Hospitals; Impaired cognition; Income; Inpatients; K-Series Research Career Programs; Logistic Regressions; Low income; Managed Care; Measures; Medicare; Medicare Part B; Mentors; Mentorship; Methodology; Methods; Michigan; Mission; National Institute on Aging; Neurocognitive; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Policies; Public Policy; Quality of Care; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Risk Factors; Science; Scientist; Testing; Training; Universities; Visit; Work; acute care; adverse outcome; beneficiary; career development; college; comorbidity; cost; effectiveness evaluation; effectiveness testing; health service use; hospital readmission; hospitalization rates; improved; indexing; male; member; payment; poor health outcome; primary outcome; professor; programs; public health relevance; racial minority; secondary outcome; statistics

PROJECT SUMMARY/ABSTRACT Hospitalizations and medication problems after discharge are a major risk factor for poor health outcomes in older adults with Alzheimer's disease and related dementia (ADRD). Increased preventable medication problems, such as unnecessary continuation of medications with neurocognitive adverse effects, emergency department visits, readmissions, and costs after hospitalization are a significant burden for older adults with ADRD. A better understanding of how patient and healthcare factors contribute to use of medications with neurocognitive effects and poor outcomes after hospitalization will inform policies to improve medication- related outcomes and care transitions in older adults with ADRD. This K08 Mentored Clinical Scientist Research Career Development Award application (PA-20-203) is to support Antoinette B. Coe, PharmD, PhD, a pharmacist-scientist and Assistant Professor in the University of Michigan College of Pharmacy. Dr. Coe's long-term goal is to become an independent investigator advancing the science of medication use in aging with a research program demonstrating ways to ensure safe and effective medication use in older adults, especially those who are vulnerable, cognitively impaired, and have ADRD. To achieve this goal, Dr. Coe will carry out the scientific aims of this proposal along with a robust career development plan in which she will acquire content expertise in cognitive impairment, ADRD, and aging, gain advanced epidemiology statistics training including causal inference methods, and develop an understanding of health and public policy impact on ADRD outcomes. The overarching scientific goal of this mentored-research proposal is to understand how poor outcomes related to medications with neurocognitive effects after a hospitalization can be mitigated in older adults with ADRD. This proposal leverages two existing Medicare care programs and payment policies that include medication reviews as potential solutions to reduce inappropriate neurocognitive medication use after care transitions: Medicare Part D Comprehensive Medication Reviews (CMR) and Part B Transitional Care Management (TCM) visits. Using nationally representative Medicare administrative data, the specific aims are as follows: 1) Identify predictors of inappropriate neurocognitive medication use in older adults with ADRD after hospitalization, 2) Examine the use of medication reviews (both CMR and TCM) among older adults who have been hospitalized and assess factors associated with their use, and 3) Test the effectiveness of comprehensive medication reviews and transitional care management on outcomes in older adults with ADRD after hospitalization. Dr. Coe will conduct all work at the rich environment of the University of Michigan, with an exceptional mentoring and advisory team led by Dr. Julie Bynum. The study's results will inform a large-scale R01-level application testing strategies to increase medication reviews in older adults with ADRD and their caregivers and motivate Medicare policy changes to ensure safe medication use in older adults with ADRD.

项目总结/摘要 出院后的住院治疗和药物问题是健康状况不佳的主要危险因素， 老年人阿尔茨海默病和相关痴呆症（ADRD）。增加可预防药物 问题，如不必要的持续用药与神经认知不良反应，紧急 对于老年人来说，去科室就诊、再入院和住院后的费用是一个沉重的负担， ADRD。更好地了解患者和医疗保健因素如何影响药物的使用， 神经认知影响和住院后的不良结局将为改善药物治疗的政策提供信息- ADRD老年患者的相关结局和护理过渡。K 08指导临床科学家 研究职业发展奖申请（PA-20-203）是为了支持安托瓦内特B。Coe，PharmD，PhD， 他是密歇根大学药学院的药剂学家兼科学家和助理教授。科医生的 长期目标是成为一名独立的研究者，推动药物在衰老中的使用科学， 一项研究计划，展示如何确保老年人安全有效地使用药物，特别是 易受伤害、认知受损和患有ADRD的患者。为了实现这一目标，科博士将开展 这项建议的科学目的沿着一个强大的职业发展计划，她将获得 认知障碍，ADRD和老龄化方面的内容专业知识，获得高级流行病学统计培训 包括因果推理方法，并了解健康和公共政策对 ADRD结局。这项指导性研究计划的首要科学目标是了解穷人 与住院后具有神经认知效应的药物相关的结局可以在老年人中得到缓解。 成人ADRD该提案利用了两个现有的医疗保险护理计划和支付政策， 包括药物审查作为潜在解决方案，以减少不适当的神经认知药物的使用， 医疗过渡：联邦医疗保险D部分综合药物审查（CMR）和B部分过渡性医疗 管理层（TCM）访视。使用具有全国代表性的医疗保险行政数据，具体目标是 如下：1）确定老年ADRD患者使用不适当的神经认知药物的预测因素， 住院，2）检查老年人使用药物审查（CMR和TCM） 住院并评估与其使用相关的因素，以及3）测试 全面的药物审查和过渡期护理管理对老年ADRD患者结局的影响 住院后。科博士将在密歇根大学丰富的环境中开展所有工作，并拥有 由Julie Bynum博士领导的卓越的指导和咨询团队。这项研究的结果将为大规模的 R 01级应用测试策略，以增加老年ADRD患者及其 护理人员和激励医疗保险政策的变化，以确保安全使用药物的老年人与ADRD。