Stuart, B. (PI), and Simoni-Wastila, L. "Chartbook on Medication Use by Aged and Disabled Medicare Beneficiaries across the Spectrum of Morbidity." The Commonwealth Fund #20060457 (2006-2007) $41,141.

Description

Chartbook on Medication Use by Aged and Disabled Medicare Beneficiaries across the Spectrum of Morbidity.

Project Officer: Stuart Gutterman, PhD

The guiding philosophy behind this small grant proposal is that building the evidence base for appropriate drug therapy for Medicare beneficiaries with complex morbidity must begin with an understanding of how medication regimens vary across the continuum of disease burden. We also recognize that it is important to anchor this building process on specific disease states, since that is how advances in medicine are achieved. We propose to profile medication utilization patterns for community dwelling ischemic heart disease, cancer, chronic obstructive pulmonary disease (COPD) and asthma, stroke (including Alzheimer's disease), pneumonia, peptic ulcer/dyspepsia and depression and other mood disorders. We selected these conditions for study based on the recommendations of a panel of experts convened by the US Department of Health and Human services to select priority conditions for analysis pursuant to Section 1013 of the Medicare Modernization Act (MMA).

As part of a companion Commonwealth Fund project #20050634, Benchmarking the Quality of Medication Use by Medicare Beneficiaries, we are developing analytical files containing detailed information about medication use for groups of Medicare Beneficiary Survey. We propose to use this small grant to compile selected results from the Benchmarking study in the form of a Commonwealth fund chartbook. The core of the chronic conditions plus an additional set for the community-dwelling Medicare each disease group will be stratified into quintiles (or perhaps deciles if sample sizes permit) based on total medical expenditures in 2002. Individual charts will depict the relationship between rising disease burden (via quintile assignment) and various factors including prevalence rates for specific disease; medical and drug spending; numbers of unique drugs and drug classes used; intensity of overall drug use as a function of medication-sensitive conditions; prevalence and intensity of use for the top five drugs; prevalence and intensity of use for drugs specifically recommended for the condition; racial and gender differences in use of selected agents, and indicators for potentially inappropriate drug use. The charts will be accompanied by key points and directions that guide readers to further details provided in a companion set of appendix tables. The front matter for the chartbook will include an introduction to the problem of developing an evidence base for appropriate prescribing across the spectrum of morbidity followed by brief sections describing the aims of the chartbook, data and methods, directions on how to make the best use of the charts, summary of cross-cutting findings, and an agenda for future research. Each disease will have a separate chapter beginning with a summary of important findings. Appendix material will include detailed tables on the characteristics of each disease group plus sections describing the MCBS, sample selection criteria, methods for measuring morbidity, the system for classifying drugs into therapeutic and pharmacological classes, and variance estimates.

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