Fragmentation of Medication Management in Medicare
Rapid Secondary Analysis to Optimize Care for Patients with Multiple Chronic Conditions –R01 Grants
Principal Investigator: Maciejewski, Matthew L.
Institution/Partners: Duke University
Project Period: 07/01/14-12/31/15
Grant Number: R01 HS023085-01
Description
Achieving continuity of medication management (COMM) in which a single prescriber manages all patient care may be challenging for patients with multiple chronic conditions (MCC). The time and expertise needed to provide guideline-recommended care may require the work of multiple providers. Research suggests that lack of COMM (i.e., more prescribers) is associated with unfavorable outcomes in MCC patients. It is necessary to further validate the COMM construct in a cohort of Medicare fee-for-service (FFS) beneficiaries with MCC. The study proposes to identify prescriber specialties by linking Part D prescription fills to identify prescriber specialty to expenditure and novel laboratory results data.
Specific Aims
- Examine the association between number of prescribers and control of diabetes and dyslipidemia.
- Examine the association between number of prescribers and adherence to medications for diabetes, hypertension or dyslipidemia.
- Examine the association between number of prescribers and Medicare expenditures.
Main Objective
Validate COMM construct and develop rigorous decision rules for counting prescribers for future analyses on a national sample of Medicare FFS beneficiaries with multiple chronic conditions.
Chronic Conditions Considered
Diabetes, hypertension, dyslipidemia
Study Design, Data Sources & Sample Size
Medicare FFS beneficiaries from 10 States linked to laboratory results data from a national laboratory vendor
Strategies Addressed from the HHS Strategic Framework on Multiple Chronic Conditions
- 4.B. Understand the epidemiology of multiple chronic conditions.
- 4.C. Increase clinical health research.
