Tanslating Research into Action for Diabetes (TRIAD) Legacy Study

项目描述：将研究转化为糖尿病的行动（TRIAD）遗留研究的目标是检查与糖尿病患者的长期护理过程、发病率、成本和死亡率相关的系统和患者水平因素。为了实现这一目标，遗产研究应用程序提出了五个具体目标。第一个目标将从2001年招募的多地点TRIAD队列中生成两份报告，其余目标将扩展我们在TRIAD D部分医疗保险研究中的工作，包括4份新报告，这些报告将分析最近从50个州获得的2007年索赔数据，这些数据来自全国最大的D部分福利提供商之一。我们的具体目的是：1)检查抑郁症和抑郁症药物使用不足与TRIAD队列患者的医疗费用和死亡率之间是否存在关联；2)使用居住在50个州的医疗保险优势部分D （MAPD）受益人的2007年数据，研究慢性疾病（如糖尿病、痴呆和抑郁症）在自付费用、空白期进入和药物依从性方面的作用；3)利用2007年收集的50个州的MAPD受益人样本数据，确定医疗保险D部分项目从通用和治疗替代中节省的潜在成本；4)检查邮购使用对D部分项目中患有糖尿病的最贫困医疗保险受益人的自付费用、总药物费用和药物依从性的影响；5)比较低收入资格（LIQ）受益人与商业计划受益人和糖尿病患者的自付药物费用、总药物费用和对慢性药物的依从性。许多由加州大学洛杉矶分校教师担任第一作者或资深作者的报告都集中在研究服务不足和/或糖尿病高危人群上。在遗产研究期间，建议的6项分析将

DESCRIPTION OF THE PROJECT: The goal of the Translating Research into Action for Diabetes (TRIAD) legacy studies is to examine the system- and patient-level factors that are associated with long-term processes of care, morbidity, costs, and mortality of persons with diabetes. To address this goal this Legacy Study application proposes five specific aims. The first aim will generate two reports from the multi-site TRIAD cohort that was recruited in 2001 and the remaining aims will extend our work on the TRIAD Part D Medicare Study with 4 new reports that will analyze recently acquired 2007 claims data from 50 states from one of the largest providers of the Part D benefit in the nation. Our specific aims are: 1) To examine whether there is an association between depression and under-use of medications for depression with medical costs and mortality for persons in the TRIAD cohort; 2) To use 2007 data from Medicare Advantage Part D (MAPD) beneficiaries who reside in 50 states to examine the role of chronic medical conditions such as diabetes, dementia, and depression on out-of-pocket costs, gap entry and adherence to medications; 3) To determine the potential cost savings in the Medicare Part D program from generic and therapeutic substitution using data from a 50-state sample of MAPD beneficiaries collected in 2007; 4) To examine the impact of mail-order use on out-of-pocket costs, total medication costs, and medication adherence for the poorest Medicare beneficiaries with diabetes in the Part D program; 5) To compare the out-of-pocket medication costs, total drug costs, and adherence to chronic medications for beneficiaries in Low Income Qualifier (LIQ) versus commercial plans and for persons with diabetes. Many of the reports that either have UCLA faculty as first or senior author have focused on studying underserved and/or high risk populations with diabetes. During the Legacy Study, the 6 analyses proposed will continue to emphasize how benefit design, cost sharing, and co-morbidities such as depression may disproportionately affect the most vulnerable persons with diabetes. A second objective of the Legacy Study is to continue to develop emerging investigators. To this end, the proposed team will continue our 11-year track record of successful mentorship and advancement of junior investigators with a strong focus on women and minority investigators by continuing to mentor Dr. O. Kenrik Duru, Assistant Professor at UCLA, and Rui Li, Ph.D., an economist at the CDC who has recently joined our team and will continue to work with us during the proposed Legacy where she will be mentored by Dr. Susan Ettner, our senior health economist, and Dr. Carol Mangione, the principal investigator of the UCLA Translational Research Center (TRC). Additionally, we expect to continue our mentoring relationships with a number of investigators from the other TRIAD TRCs. Finally, during the TRIAD Legacy phase we expect to be full participants in the steering and publication committee activities that will be vital to the success of the final stage of this ground-breaking study.