Quality of Epilepsy Treatment and Costs in Older Americans by Race (QUIET CARE)

描述(由申请人提供)：截至今天，我们对患有癫痫的美国老年人，特别是通常处于不利地位的少数族裔，接受安全有效的抗癫痫药物治疗(AED)和后续护理的程度了解有限。癫痫的发病率在老年人和儿童时期达到高峰，在一些少数群体中更高；例如， 与白人医疗保险受益人相比，非裔美国人(AA)的比例高出80%。适当的治疗对于优化癫痫发作控制的机会至关重要。基于成人治疗的有效性和安全性数据，2007年制定了癫痫治疗质量指标(INITE)，以评估护理质量。以前的文献表明，并不是所有的种族群体都得到了安静、和谐的照顾。此外，AED依从性差，在少数族裔中通常也更常见，限制了癫痫控制。改善所有老年癫痫患者的护理和对AED治疗的依从性，有可能防止可避免的癫痫发作，并降低医疗成本。我们的长期目标是提供信息并设计干预措施，以改善患有癫痫的老年少数民族的医疗保健，并降低与可预防事件相关的医疗保健成本。此应用程序的目的是检查当前AED的质量和依从性，以及老年美国种族群体反复癫痫发作后当前的护理质量，并确定改善护理质量和降低医疗成本的机会，作为迈向长期目标的第一步。这项研究的基本原理是它是 这对于推动实现癫痫患者健康生活的国家目标，并有可能降低数十万患有这种疾病的联邦医疗保险受益人的医疗费用至关重要。我们计划通过使用Medicare管理声明和有效的算法从这些数据中识别癫痫病例来实现我们的目标，以实现以下具体目标：1)评估患有癫痫的Medicare受益人种族群体的AED治疗质量。我们的假设是，与白人受益人相比，通常处于不利地位的少数族裔(例如，AA、美洲原住民、西班牙裔)不太可能接受安静、协调的AED治疗，也不太可能坚持AED；2)决定癫痫复发后跨种族的护理质量。我们假设少数受益者在反复发作后不太可能得到安静和谐的护理。利用获得保健的行为模型，对目标1和目标2的分析将确定除其他外，药物计划的当前特点和保健的地理差异对种族差异的影响；3)确定较低的保健费用是否与各种族群体之间安静、和谐的保健有关。如果H1-H3是正确的，我们假设少数族裔受益人更有可能 有很高的潜在可预防的医疗保健成本。这一新颖的项目将产生积极影响，因为它将提供急需的信息，推动该领域改善癫痫治疗，减少差距，并潜在地降低老年人的成本。 公共卫生相关性：拟议的研究与公共健康相关，因为了解少数群体中的老年人是否正在接受最大限度地控制癫痫发作和提高生活质量的护理，有望为提供者和/或患者提供干预措施，最终导致癫痫患者生活良好， 缩小差距，同时降低医疗成本。因此，这项拟议的研究与国家神经疾病研究所(NINDS)S的目标有关，即确保生活中没有 对于所有患有癫痫的美国人来说，这一点尤其重要，因为美国医疗系统正在处理越来越多的患有癫痫的老年人。

DESCRIPTION (provided by applicant): As of today, we have limited knowledge on the extent to which older Americans with epilepsy, especially typically disadvantaged minorities, receive antiepileptic drug treatment (AED) and follow-up care that is safe and effective. Epilepsy incidence peaks in older age as well as in childhood, and is higher in some minorities; e.g., it is 80% higher in African American (AA) compared to white Medicare beneficiaries. Appropriate treatment is crucial to optimize the chances of seizure control. Based on adult treatment effectiveness and safety data, the Quality Indicators for Epilepsy Treatment (QUIET) were developed in 2007 to assess quality of care. Previous literature suggests not all racial groups receive QUIET concordant care. In addition, poor AED adherence, also typically more common among minorities, limits seizure control. Improving care and adherence to AED treatment in all older adults with epilepsy has the potential to prevent avoidable seizures and also reduce medical costs. Our long-term goal is to inform and design interventions that improve the health care for older minorities with epilepsy and reduce health care costs associated with preventable events. The objective of this application is to examine the current quality of, and adherence to, AEDs and the current quality of care after recurrent seizures across racial groups of older Americans, and to identify opportunities for quality of care improvements and health care costs reductions as a first step toward the long term goal. The rationale for this research is that it is fundamental to inform the progression toward the national objective of living well with epilepsy and potentially reduce health care costs for the hundreds of thousands Medicare beneficiaries who suffer from this disorder. We plan to accomplish our objective by using Medicare administrative claims and a validated algorithm to identify epilepsy cases from these data, to pursue the following specific aims: 1) Assess quality of AED treatment across racial groups of Medicare beneficiaries with epilepsy. Our hypothesis is that, compared to white beneficiaries, typically disadvantaged minorities (e.g., AAs, Native Americans, Hispanics) are less likely to have QUIET concordant AED treatment and less likely to adhere to AEDs; 2) Determine the quality of care after seizure recurrence across race. We hypothesize that minority beneficiaries are less likely to have QUIET concordant care after recurrent seizures. Using the Behavioral Model of Access to Care, analyses for aims 1 and 2 will determine the contribution to racial disparities of, among others, current features of drug plans and geographic variation in care; and 3) determine if lower health care costs are associated with QUIET concordant care across racial groups. If H1-H3 are correct, we hypothesize that minority beneficiaries will be more likely to have high potentially preventable health care costs. This novel project will have a positive impact because it will provide much needed information to move the field toward improving epilepsy care, reducing disparities and potentially reducing costs for older adults. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because understanding whether older adults across minority groups are receiving the care that maximizes the chances of seizure control and good quality of life is expected to inform interventions for providers and/or patients that will ultimately lead to living well with epilepsy, reduce disparities as well as reduce health care costs. Thus, the proposed research is relevant to the National Institute of Neurological Disorders (NINDS)'s objective of assuring a life with "no seizure, no side effects" for all Americans with epilepsy. This is especially important as the US healthcare system deals with an ever increasing number of older adults with epilepsy.