EFFECTIVENESS OF RETROSPECTIVE DRUG UTILIZATION REVIEW

不当用药是一种重要的公共卫生问题 有问题。因为老年人更有可能有同伴 疾病和药物，它们有最大的不良反应风险 结果。例如，在老年人中进行的一项研究发现 28%的入院患者是由于药物问题，以及 显示医疗补助受助者的比例特别高 风险。药物利用审查(DUR)是一种寻求 减少不当处方的后果。部分原因是 联邦授权，追溯性DUR现在适用于数百万人 老年美国人，包括所有参加医疗补助的人和70岁- 所有有处方药保险的人的5%。 尽管完全没有严格的证据表明 DUR在改变药物治疗或改善疗效方面是有效的 健康结果。鉴于现有的联邦授权，一项试验性的 在医疗补助人群中进行DUR试验是不可行的。因此， 对DUR有效性的及时、良好控制的观察性试验 是非常需要的。 宾夕法尼亚大学有一个独特的机会来进行 DUR对处方影响的严格观察性试验 模式和临床结果。使用大型、唯一的数据 来源：我们打算评估DUR对这两个过程的影响 测量和临床结果测量。我们的方法论 Proposal包含干预前和干预后的比较，以及 并发控制。这将使我们能够测量一些 DUR的重要影响，控制可能的影响 国家方案和因果无关的世俗方案之间的差异 趋势。我们打算采用三种不同的、互补的抽样。 提出学习问题的框架。研究问题 都经过了精心挑选，并解决了实际和 理论上的重要性。 这项研究的结果，无论是积极的还是消极的，都将 广泛的卫生政策和科学影响，特别是 关于老年人。宾夕法尼亚大学有一个很棒的 在药物结果研究项目方面有丰富的经验 像这样，特别是那些使用大型索赔数据库的人。这个 调查人员将能够提供明确、有意义的答案 这项研究在很短的时间内提出问题，并在非常短的时间内完成 具有成本效益的方式。

Improper prescribing of medications is an important public health problem. Because the aged are more likely to have concomitant illnesses and medications, they are at greatest risk for adverse outcomes. For example, one study conducted in the elderly found that 28% of hospital admissions were due to medication problems, and showed that Medicaid recipients were at an especially increased risk. Drug utilization review (DUR) is a procedure that seeks to reduce the consequences of improper prescribing. In part because of federal mandate, retrospective DUR is now being applied to millions of older Americans, including all Medicaid enrollees and seventy- five percent of all people with prescription insurance coverage. This is despite the complete absence of rigorous evidence indicating that DUR is effective in either altering drug therapy or improving health outcomes. Given the existing federal mandate, an experimental trial of DUR in the Medicaid population is infeasible. Therefore, a timely, well-controlled observational trial of DUR's effectiveness is badly needed. The University of Pennsylvania has a unique opportunity to conduct a rigorous observational trial of DUR's effects on prescribing patterns and on clinical outcomes. Using a large, unique data source, we intend to evaluate the effects of DUR on both process measures and clinical outcome measures. The methodology that we propose incorporates both pre-post intervention comparisons, and concurrent controls. This will enable us to measure a number of important effects of DUR, controlling for possible effects of differences between state programs and causally unrelated secular trends. We intend to employ three distinct, complementary sampling frames from which to pose the study questions. The study questions have been carefully selected, and address issues of practical and theoretical importance. The results of this study, whether positive or negative, will have wide-ranging health policy and scientific implications, especially with regard to the aged. The University of Pennsylvania has a great deal of experience in pharmaceutical outcomes research projects such as this, especially those using large claims databases. The investigators will be able to provide clear, meaningful answers to the study questions in a very short time-frame, and do so in a very cost-efficient manner.