Cargando…
Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System
BACKGROUND: The Medicare star ratings system incentivizes health plan sponsors based on their performance across a measurement system that contains quality measures related to medication use. As health plan sponsors seek to further engage their network providers, specifically network pharmacies, to...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Academy of Managed Care Pharmacy
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402692/ https://www.ncbi.nlm.nih.gov/pubmed/27348278 http://dx.doi.org/10.18553/jmcp.2016.22.7.779 |
_version_ | 1785084899402711040 |
---|---|
author | Desai, Vibha Nau, David Conklin, Mark Heaton, Pamela C. |
author_facet | Desai, Vibha Nau, David Conklin, Mark Heaton, Pamela C. |
author_sort | Desai, Vibha |
collection | PubMed |
description | BACKGROUND: The Medicare star ratings system incentivizes health plan sponsors based on their performance across a measurement system that contains quality measures related to medication use. As health plan sponsors seek to further engage their network providers, specifically network pharmacies, to improve performance on these measures, it is important to consider the effect of environmental factors on the performance of network pharmacies. OBJECTIVE: To determine the effect of environmental factors on pharmacy quality as measured by (a) medication adherence for noninsulin diabetes medications, (b) medication adherence for renin angiotensin receptor antagonists (RASA), (c) medication adherence for cholesterol medications (statins), and (d) use of high-risk medications (HRM) in the elderly. METHODS: The EQuIPP database, which contains performance information for pharmacies for a nationwide sample of Medicare beneficiaries, was used for this analysis. Environmental factors included regions or characteristics of a community or county. County-level data was obtained from the Area Health Resource Files, a resource product available from the Health Resources & Service Administration. A logistic regression model was developed with performance as the dependent variable and regions and environmental factors as independent variables. Performance and county characteristics, such as proportion of patients in an age group, race, income, or number of outpatient visits, were classified as high and low based on a median cutoff of nationwide performance scores. RESULTS: A total of 28,950 pharmacies were included in this analysis. For most measures, the proportion of low-performing pharmacies was significantly higher in the East South Central, Mid-Atlantic, Mountain, Pacific, and West South Central regions. Pharmacies in counties with high median income, high proportion of elderly population (aged > 84 years), high proportion of elderly patients who were white or Hispanic, high proportion of elderly males, and high proportion of elderly urban patients were less likely to have low performance, whereas those with high proportion of elderly African Americans and high density of independent pharmacies were more likely to have low performance (P < 0.05-0.0001). CONCLUSIONS: This study found that environmental characteristics of a region, including pharmacy and sociodemographic characteristics, explained regional variation in quality measures related to medication use for patient populations served by pharmacies. This evaluation serves to further inform the discussion regarding case-mix adjustment of quality measures and provides information that may be important to further refine intervention strategies for pharmacies and pharmacists who serve certain regional populations. Additionally, pharmacies in greatest need of support for quality improvement may be those who serve populations that are predominantly low income and elderly African American. |
format | Online Article Text |
id | pubmed-10402692 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Academy of Managed Care Pharmacy |
record_format | MEDLINE/PubMed |
spelling | pubmed-104026922023-08-05 Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System Desai, Vibha Nau, David Conklin, Mark Heaton, Pamela C. J Manag Care Spec Pharm Research BACKGROUND: The Medicare star ratings system incentivizes health plan sponsors based on their performance across a measurement system that contains quality measures related to medication use. As health plan sponsors seek to further engage their network providers, specifically network pharmacies, to improve performance on these measures, it is important to consider the effect of environmental factors on the performance of network pharmacies. OBJECTIVE: To determine the effect of environmental factors on pharmacy quality as measured by (a) medication adherence for noninsulin diabetes medications, (b) medication adherence for renin angiotensin receptor antagonists (RASA), (c) medication adherence for cholesterol medications (statins), and (d) use of high-risk medications (HRM) in the elderly. METHODS: The EQuIPP database, which contains performance information for pharmacies for a nationwide sample of Medicare beneficiaries, was used for this analysis. Environmental factors included regions or characteristics of a community or county. County-level data was obtained from the Area Health Resource Files, a resource product available from the Health Resources & Service Administration. A logistic regression model was developed with performance as the dependent variable and regions and environmental factors as independent variables. Performance and county characteristics, such as proportion of patients in an age group, race, income, or number of outpatient visits, were classified as high and low based on a median cutoff of nationwide performance scores. RESULTS: A total of 28,950 pharmacies were included in this analysis. For most measures, the proportion of low-performing pharmacies was significantly higher in the East South Central, Mid-Atlantic, Mountain, Pacific, and West South Central regions. Pharmacies in counties with high median income, high proportion of elderly population (aged > 84 years), high proportion of elderly patients who were white or Hispanic, high proportion of elderly males, and high proportion of elderly urban patients were less likely to have low performance, whereas those with high proportion of elderly African Americans and high density of independent pharmacies were more likely to have low performance (P < 0.05-0.0001). CONCLUSIONS: This study found that environmental characteristics of a region, including pharmacy and sociodemographic characteristics, explained regional variation in quality measures related to medication use for patient populations served by pharmacies. This evaluation serves to further inform the discussion regarding case-mix adjustment of quality measures and provides information that may be important to further refine intervention strategies for pharmacies and pharmacists who serve certain regional populations. Additionally, pharmacies in greatest need of support for quality improvement may be those who serve populations that are predominantly low income and elderly African American. Academy of Managed Care Pharmacy 2016-07 /pmc/articles/PMC10402692/ /pubmed/27348278 http://dx.doi.org/10.18553/jmcp.2016.22.7.779 Text en © 2016, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited. |
spellingShingle | Research Desai, Vibha Nau, David Conklin, Mark Heaton, Pamela C. Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title | Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title_full | Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title_fullStr | Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title_full_unstemmed | Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title_short | Impact of Environmental Factors on Differences in Quality of Medication Use: An Insight for the Medicare Star Rating System |
title_sort | impact of environmental factors on differences in quality of medication use: an insight for the medicare star rating system |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402692/ https://www.ncbi.nlm.nih.gov/pubmed/27348278 http://dx.doi.org/10.18553/jmcp.2016.22.7.779 |
work_keys_str_mv | AT desaivibha impactofenvironmentalfactorsondifferencesinqualityofmedicationuseaninsightforthemedicarestarratingsystem AT naudavid impactofenvironmentalfactorsondifferencesinqualityofmedicationuseaninsightforthemedicarestarratingsystem AT conklinmark impactofenvironmentalfactorsondifferencesinqualityofmedicationuseaninsightforthemedicarestarratingsystem AT heatonpamelac impactofenvironmentalfactorsondifferencesinqualityofmedicationuseaninsightforthemedicarestarratingsystem |