Health Implications of MTM Eligibility Criteria

描述(由申请人提供)：2006年由医疗保险和医疗补助服务中心(CMS)实施的联邦医疗保险处方药、改善和现代化法案(MMA)要求联邦医疗保险受益人的处方药(D部分)计划建立药物治疗管理(MTM)计划，目的是“通过改善药物使用和减少不良事件来优化治疗结果...”MTM服务对患有慢性病的患者特别有益，在这些患者的管理中，药物治疗发挥着重要作用，如高血压和糖尿病，特别是老年人。由于这些疾病的患病率和对这些疾病控制不力的流行率在种族和族裔少数群体中比白人更高，MTM可以成为缩小这些差距的重要工具。然而，我们最近发表的对历史数据的分析表明，与白人相比，种族和少数民族更不可能有资格获得MTM。这一结果并不令人惊讶，因为MTM的资格标准主要基于以前的药物使用情况和成本，而且种族和少数民族历来倾向于使用较少的处方药，并产生比白人更低的处方药成本。为了了解抗癌药物资格标准对少数族裔的健康影响，我们建议解决符合抗癌药物资格的个人在健康状况、医疗服务利用和费用以及药物使用模式方面的种族和民族差异是否与不符合抗癌药物资格的个人的差异不同。这是一个重要的问题，因为不符合MTM资格的个人之间的较大差距将表明，MTM资格标准有可能加剧种族和族裔差距。重要的是将健康状况、医疗服务利用和成本以及药物利用模式作为研究结果，因为2010年《患者保护和负担能力护理法案》(PPACA)和现有文献将这些方面的改善确定为通过提供MTM服务实现的结果。还报告了所有这些方面的种族和族裔差异。国家老龄研究所已将医疗保险受益者中的种族和民族差异确定为资金优先事项。我们的具体目标是，使用与联邦医疗保险索赔记录相关联的联邦医疗保险当前受益人调查，根据各种政府法规和政策，比较符合MTM资格和不符合MTM资格的Medicare受益人之间的种族和民族差异。我们将利用D部分实施前后的数据分析政策情景，将2004-2005年和2007-2008年相对于2001-2002年至2004-2005年的变化进行比较，并确定MMA和PPACA中规定的MTM资格标准的影响。我们将使用各种多变量建模技术。由于我们的试点数据已经显示，不符合MTM资格的人在健康状况方面的种族差异比符合MTM条件的人更大，因此这项研究极有可能产生有意义的结果。我们的长期目标是确定能够缩小差距的政府政策和国会立法的类型。 公共卫生相关性：国家老龄研究所已将医疗保险受益者之间的种族和民族差异确定为资金优先事项。这项研究项目评估了联邦政策对联邦医疗保险受益人药物治疗管理服务的影响，包括健康状况、医疗服务利用和成本、药物利用模式以及对治疗结果差异的影响方面的种族和民族差异。

DESCRIPTION (provided by applicant): The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) implemented in 2006 by the Centers for Medicare and Medicaid Services (CMS) requires prescription drug (Part D) plans for Medicare beneficiaries to establish medication therapy management (MTM) programs with a purpose to "optimize therapeutic outcomes ... by improving medication use and reducing adverse events..." MTM services are particularly beneficial for patients with chronic diseases, in whose management pharmacotherapy plays a major role, such as hypertension and diabetes, and especially the elderly. Because the prevalence of these diseases and prevalence of poor control of them are higher in racial and ethnic minorities than Whites, MTM could be an important tool for reducing these disparities. However, our recently published analyses of historical data demonstrate that racial and ethnic minorities would be less likely to be eligible for MTM than Whites. This result is not surprising considering that MTM eligibility criteria are based predominantly on previous drug utilization and costs, and racial and ethnic minorities historically tend to use fewer prescription drugs and incur lower prescription drug costs than do Whites. To understand the health implications of MTM eligibility criteria for minorities, we propose to address whether the racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-eligible individuals are different from the disparities among MTM-ineligible individuals. This is an important question because greater disparities among MTM-ineligible individuals would suggest that the MTM eligibility criteria have the potential to aggravate racial and ethnic disparities. It is important to include as study outcomes health status, health services utilization and costs, and medication utilization patterns, because the 2010 Patient Protection and Affordability Care Act (PPACA) and the existing literature identified improvements of these aspects as outcomes to achieve through providing MTM services. Racial and ethnic disparities in all these aspects have also been reported. The National Institute on Aging has identified racial and ethnic disparities among Medicare beneficiaries as a funding priority. Our Specific Aim is to compare, using the Medicare Current Beneficiary Survey linked to Medicare claims records, racial and ethnic disparities in study outcomes among MTM-eligible and MTM- ineligible Medicare beneficiaries based on various government regulations and policies. We will analyze policy scenarios by using data from before and after Part D implementation, comparing 2004-2005 and 2007-2008 relative to changes from 2001-2002 to 2004-2005, and determine the impact of the MTM eligibility criteria laid out in MMA and PPACA. We will use a variety of multivariate modeling techniques. Because our pilot data already showed greater racial disparities in health status among the MTM-ineligible than the MTM-eligible, this study is highly likely to produce meaningful results. Our long-term goal is to determine the types of government policies and congressional legislations that can reduce disparities. PUBLIC HEALTH RELEVANCE: The National Institute on Aging has identified racial and ethnic disparities among Medicare beneficiaries as a funding priority. This research project assesses the impact of Federal policies on medication therapy management services for Medicare beneficiaries in terms of racial and ethnic disparities in health status, health services utilization and costs, medication utilization patterns, and the implications for disparities in therapeutic outcomes.