Health Implications of MTM Eligibility Criteria

描述（由申请人提供）：由医疗保险和医疗补助服务中心（CMS）于2006年实施的医疗保险处方药，改进和现代化法案（MMA）要求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“优化治疗结果……通过改善药物使用和减少不良事件……”MTM服务对慢性病患者尤其有益，在这些疾病的治疗中，药物治疗起着主要作用，例如高血压和糖尿病患者，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良的患病率在种族和少数民族中高于白人，MTM可能是缩小这些差异的重要工具。然而，我们最近发表的对历史数据的分析表明，种族和少数民族比白人更不可能有资格获得MTM。考虑到MTM的资格标准主要基于以前的药物使用和成本，并且种族和少数民族历史上倾向于使用较少的处方药，并且比白人产生更低的处方药成本，这一结果并不令人惊讶。为了了解MTM资格标准对少数民族的健康影响，我们建议探讨MTM合格个体在健康状况、卫生服务利用和成本以及药物利用模式方面的种族和民族差异是否与MTM不合格个体之间的差异不同。这是一个重要的问题，因为不符合MTM资格的个人之间的更大差异将表明MTM资格标准有可能加剧种族和民族差异。将健康状况、卫生服务利用和成本以及药物利用模式纳入研究结果是很重要的，因为2010年《患者保护和可负担医疗法案》（PPACA）和现有文献确定了通过提供MTM服务来改善这些方面的结果。还报道了所有这些方面的种族和族裔差异。美国国家老龄问题研究所（National Institute on Aging）已将医疗保险受益人之间的种族和民族差异确定为资助重点。我们的具体目的是利用与医疗保险索赔记录相关的医疗保险现行受益人调查，比较基于各种政府法规和政策的MTM合格和不合格医疗保险受益人之间研究结果的种族和民族差异。我们将使用D部分实施前后的数据来分析政策情景，比较2004-2005年和2007-2008年与2001-2002年和2004-2005年的变化，并确定MMA和PPACA中规定的MTM资格标准的影响。我们将使用多种多元建模技术。由于我们的试点数据已经显示，在不符合mtm条件的人群中，健康状况的种族差异比符合mtm条件的人群更大，因此本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减少不平等的政府政策和国会立法的类型。

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.