医疗保险星级评级措施后的综合药物审查完成率和差异
Anna Hung1,2,3, Lauren Wilson1, Valerie A Smith1,3,4
1Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
JAMA health forum
|May 3, 2024
概括
美国医疗保险 (Medicare) 的医疗保险.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策分析 卫生政策分析
背景情况:
- 综合药物审查 (CMR) 对于优化医疗保险受益者药物治疗方案和结果至关重要.
- 2016年,医疗保险将CMR完成纳入其星级评级质量措施,以激励其使用.
研究的目的:
- 分析2016年星级评级实施前后CMR完成率的趋势.
- 调查CMR完成过程中种族,种族和社会经济差异的变化.
主要方法:
- 使用中断时间序列分析的观察性研究.
- 从2013年到2020年,检查了66岁以上的社区住户医疗保险受益人的年度队列.
- 通用估计方程模拟CMR完成率.
主要成果:
- 未调整的CMR完成率在2016年后大幅增加,部分原因是更严格的D部分计划资格标准.
- 亚裔和西班牙裔受益者,以及双重医疗补助计划的受益者,在CMR完成的可能性上显示出更大的增加,但与白人受益者相比,他们完成CMR的可能性仍然较低.
- 虽然差异减少了,但并没有消除.
结论:
- 医疗保险星级评级质量措施激励了更高的CMR完成率.
- 质量措施可以影响计划行为,并可能解决健康差异.
- 可能需要进一步干预,以完全消除CMR完成的差异.
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