The Continuity of Medication Management (COMM) Study

描述(由申请人提供)：更好的护理连续性与改善护理质量、减少急诊室就诊和因门诊护理敏感情况而住院的情况有关。有了更好的连续性，患者和提供者之间的互动是富有成效的，建立了信任，患者得到了适当和及时的预防性护理和慢性病管理。这种理想化的护理连续性很少实现，特别是对于患有多种慢性病的患者，因为在2000-2002年间，平均每个医疗保险服务费用受益人见了两名初级保健医生和五名专家。为了改善慢性病患者的护理协调和管理，提出了以患者为中心的医疗之家，提供单一、一致的护理点，为患者提供连续的临床信息和治疗决策。利用信息技术促进纵向关系、护理协调和综合性的医疗之家有望改善对慢性病患者，特别是多种疾病患者的护理。然而，护理和医疗院的连续性不仅关系到适当和及时地提供单点护理的卫生服务，而且还关系到适当和及时地开出新药以及改变现有药物的剂量。然而，到目前为止，还没有研究调查反映疗养院原则的患者护理是否改善了药物管理的连续性以及多种慢性病患者的健康和经济结果。我们将通过五个目标来解决这一差距：1)为两个或更多ACSC服药的患者是否比为一个ACSC服药的患者有更多的处方提供者？2)为两个或更多ACSC服药的患者是否比为一个ACSC服药的患者开出更多的药物，并且服药依从性更差？3)为两个或更多ACSC服药的患者是否比为一个ACSC服药的患者有更多的急诊室就诊和住院次数？4)为两个或更多ACSC服药的患者比为一个ACSC服药的患者有更多的自我报告的药物问题？5)患者和他们的提供者有什么您认为拥有一个处方提供者或多个处方提供者的优点和缺点是什么？医疗之家的实施工作可能需要明确协调处方模式，以优化患者结果，如果我们发现处方较少(或单一)的患者比处方较多的患者有更好的依从性，较少的急诊室就诊和住院，以及较少的自我报告的用药问题。研究结果还可能为自我转诊很常见的卫生系统的未来评估提供目标，并为未来的干预发展提供目标。 公共卫生相关性：理想的连续性护理是指在所有办公室就诊时都去看同一名医生，但这也涉及到适当和及时地开出新药以及改变现有药物的剂量。药物管理的连续性还没有得到广泛的研究，因此拟议的研究的目的是检查患有两种或两种以上慢性病的退伍军人持续药物管理的健康和经济后果。

DESCRIPTION (provided by applicant): Better continuity of care has been associated with improved quality of care, and reduced emergency room visits and hospitalizations for ambulatory care sensitive conditions. With better continuity, interactions between patients and providers are productive, trust is established, and patients receive appropriate and timely preventive care and chronic disease management. This idealized version of care continuity is rarely realized particularly for patients with multiple chronic conditions, because the average Medicare fee-for-service beneficiary saw two primary care physicians and five specialists in 2000-2002. To improve care coordination and management of patients with chronic conditions, the patient-centered medical home has been proposed to provide a single, consistent point of care that provides continuity of clinical information and treatment decisions for the patient. Medical homes that leverage information technology to promote longitudinal relationships, care coordination and comprehensiveness, hold promise for improving the care for patients with chronic conditions, particularly patients with multiple conditions. However, continuity of care and medical homes relate not just to appropriate and timely provision of health services with a single point of care, but also to appropriate and timely prescribing of new medications and changing in dosing for existing medications. However, no study to date has examined whether patient care that reflects the principles of a medical home improves the continuity of medication management and health and economic outcomes for patients with multiple chronic conditions. We will address this gap in five aims: 1) Do patients taking medications for two or more ACSCs have more prescribing providers than patients taking medications for one ACSC? 2) Do patients taking medications for two or more ACSCs have more medications prescribed and worse medication adherence than patients taking medications for one ACSC? 3) Do patients taking medications for two or more ACSCs have more emergency room visits and inpatient admissions than patients taking medications for one ACSC? 4) Do patients taking medications for two or more ACSCs have more self-reported medication problems than patients taking medications for one ACSC? 5) What do patients and their providers perceive as the advantages and disadvantages of having a single prescribing provider or multiple prescribing providers? Medical home implementation efforts may need to explicitly coordinate prescribing patterns to optimize patient outcomes if we find that patients with fewer (or a single) prescribers have better adherence, fewer emergency room visits and admissions, and fewer self-reported medication problems than patients with more prescribers. Study results are also likely to suggest targets for future evaluation in health systems where self-referral is common and targets for future intervention development. PUBLIC HEALTH RELEVANCE: Ideal continuity of care has been referred to as seeing the same doctor for all office visits, but it also relates to appropriate and timely prescribing of new medications and changing in dosing for existing medications. Continuity in medication management has not been examined widely, so the purpose of the proposed study is to examine the health and economic consequences of continuity of medication management for veterans with two or more chronic conditions.