Clinical and medication use characteristics of national cohort of elderly dementia patients

Abstract

Little is known about how Medicare Part D Comprehensive Medication Review (CMR) affects quality of medication use and management. In this study, changes of plan level CMR completion rates over time were examined and their associations with medication use and management related (MUMR) quality measures.Using Medicare Part D plan Star Rating and contract information data, a longitudinal data set was developed with CMR completion rate and 17 MUMR measures. T-tests and one-way Analysis of Variance were used to examine the variation of CMR rates between contracts and over time, respectively, as well as the regression adjusted associations using fixed-effects and ordinary least squares models, verified by Generalized Estimating Equations.CMR completion rates increased substantially from contract year 2013–2016, with a larger increase among Medicare Advantage Prescription Drug Plans than stand-alone Prescription Drug Plans. Prior year's CMR completion rates had marginally positive effects on 4 of the 17 MUMR measures: medication adherence with statin drugs, continuous beta blocker treatment, and pharmacotherapy management of chronic obstructive pulmonary disease exacerbation (systemic corticosteroid or bronchodilator). Increasing CMR completion also was associated with increased chronic use of atypical antipsychotics by elderly beneficiaries in nursing homes, an unintended outcome and a reflection of poor quality of care. CMR completion rates in the same year had even more limited associations with other MUMR measures.At plan level, CMR completion rates had limited and inconsistent association with other MUMR measures. Although our research used an observational study design, the associations observed have policy implications to the Center for Medicare & Medicaid (CMS) Star Ratings program and quality bonus payments, as well as implications for plans' quality improvement.