Stuart, B. (PI), Simoni-Wastila, L. (Co-I), Zuckerman, I.H. (Co-I) "Benchmarking the Quality of Medication Use by Medicare Beneficiaries," The Commonwealth Fund, #20050634 (8/1/2005 - 1/31/2007).

Description

Benchmarking the Quality of
Medication Use by Medicare Beneficiaries

The impending implementation of Part D drug coverage for Medicare beneficiaries has generated considerable interest within the health policy and clinical communities in gaining a better understanding of beneficiary drug utilization patterns and how they might be impacted by the new law.  Of particular concern is how the quality of medication use can be assured under the complex Part D benefit structure.  Several features of the MMA focus on ways to improve quality (and reduce cost) of medication use through chronic care improvement demonstration projects (now known as Medicare Health Support), mandated medication therapy management programs, and new authority for Medicare Quality Improvement Organizations.   However, for these efforts to succeed there needs to be a recognized set of benchmarks against which progress can be measured.  At present these benchmarks do not exist.  Although there have been significant developments in evidence-based clinical guidelines for treating many of the chronic diseases prevalent in the Medicare population, there is no systematic published research on the most basic question of all; namely, what drugs are Medicare beneficiaries currently taking for which disease states?  Until that question is answered, it is difficult if not impossible to assess the effort that will be required to bring utilization patterns in line with accepted standards of care. 

The first objective of this project is thus to describe the pharmacotherapeutic profiles of a nationally representative sample of Medicare beneficiaries classified by disease state.  For this task we propose to focus on the 10 priority conditions identified by DHHS for research under the Medicare Modernization Act.  The second objective of the project is to analyze specific factors associated with areas of concern.  Our preliminary work suggests that three factors deserve in-depth attention: disease burden or “polymorbidity,” residence in long-term care settings, and disparities by race and other beneficiary characteristics.  We propose to analyze each factor in a separate paper.  Other relevant factors identified during the course of the study will be reviewed for potential co-funding by AHRQ if funds become available for extramural studies in this area, or for future research proposals to CMWF or other funders.

Presentations

None at this time.