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

项目摘要/摘要 出院后住院和用药问题是#年健康状况不佳的主要风险因素。 阿尔茨海默病和相关痴呆症(ADRD)的老年人。增加可预防的药物治疗 问题，如不必要地继续服用具有神经认知不良影响的药物，紧急情况 对老年人来说，住院后的科室就诊、再住院和费用是一个重大负担 阿德勒。更好地了解患者和医疗保健因素如何影响药物的使用 神经认知效应和住院后糟糕的结果将为改善药物治疗的政策提供信息- 老年ADRD患者的相关结局和护理过渡。这位K08指导了临床科学家 申请研究职业发展奖(PA-20-203)是为了支持Antoinette B.Coe，药学博士，博士， 药剂师兼科学家，密歇根大学药学院助理教授。科医生的 长期目标是成为一名独立的调查者，推动老龄化用药科学的发展 一项研究计划，展示了确保老年人安全有效用药的方法，特别是 那些易受伤害、认知受损和患有ADRD的人。为了实现这一目标，科博士将进行 这项提议的科学目标以及她将在其中获得的稳健的职业发展计划 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，并发展对健康和公共政策影响的理解 ADRD结果。这项有指导的研究提案的首要科学目标是了解 住院后与神经认知影响的药物相关的结果可以在老年人中缓解 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的解决方案，以减少不适当的神经认知药物使用后 过渡护理：联邦医疗保险D部分全面用药审查(CMR)和B部分过渡护理 管理(中医)访问。使用具有全国代表性的医疗保险管理数据，具体目标是 如下：1)确定ADRD老年患者在治疗后不适当使用神经认知药物的预测因素 住院，2)检查在有以下情况的老年人中使用药物评论(CMR和中医)的情况 住院并评估与其使用相关的因素，以及3)测试 综合用药回顾和过渡期护理管理对老年ADRD患者预后的影响 住院后。科博士将在密歇根大学丰富的环境中进行所有工作， 由朱莉·拜纳姆博士领导的杰出的指导和咨询团队。这项研究的结果将为大规模 R01级应用程序测试策略，以增加患有ADRD和他们的老年人的药物审查 并推动医疗保险政策的变化，以确保患有ADRD的老年人安全用药。

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.