Becky A. Briesacher, PhD; Jeanne M. Madden, PhD; Fang Zhang, PhD; Hassan Fouayzi, MS; Dennis Ross-Degnan, ScD; Jerry H. Gurwitz, MD; Stephen B. Soumerai, ScD
Preliminary findings from this study were presented at the Pharmaceutical Policy Research Seminar at Harvard Medical School in Boston, Massachusetts, in May 2013 and at the Quantitative Health Science Methods Seminar at University of Massachusetts in Worcester, Massachusetts, in April 2013.
Disclaimer: Dr. Briesacher had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Grant Support: By the National Institute on Aging (NIA) (grants R01AG028745 and R01AG022362; Dr. Soumerai [principal investigator]), a Research Scientist Award from the NIA (K01AG031836; Dr. Briesacher), and related support from the NIA and Agency for Healthcare Research and Quality (grants R01AG032249 and R01HS018577, respectively; Drs. Madden, Zhang, Ross-Degnan, and Soumerai).
Disclosures: Dr. Briesacher reports grants from National Institutes of Health during the conduct of the study and grants from Daiichi Sankyo outside the submitted work. Mr. Fouayzi received an unrestricted research grant from Daiichi Sankyo for an unrelated study. Dr. Ross-Degnan reports grants from National Institute of Aging during the conduct of the study and grants and personal fees from Novartis Pharma outside the submitted work. Dr. Gurwitz reports grants from National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0726.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Briesacher (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Becky A. Briesacher, PhD, School of Pharmacy, Northeastern University, 360 Huntington Avenue, R218 TF, Boston, MA 02115; e-mail, email@example.com.
Current Author Addresses: Dr. Briesacher: School of Pharmacy, Northeastern University, 360 Huntington Avenue, R218 TF, Boston, MA 02115.
Drs. Madden, Zhang, Ross-Degnan, and Soumerai: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.
Mr. Fouayzi and Dr. Gurwitz: Department of Medicine, Division of Geriatric Medicine, University of Massachusetts Medical School, 365 Plantation Street, Biotech One, Suite 100, Worcester, MA 01605.
Author Contributions: Conception and design: B.A. Briesacher, J.M. Madden, F. Zhang, H. Fouayzi, D. Ross-Degnan, J.H. Gurwitz, S.B. Soumerai.
Analysis and interpretation of the data: B.A. Briesacher, J.M. Madden, F. Zhang, H. Fouayzi, S.B. Soumerai.
Drafting of the article: B.A. Briesacher, D. Ross-Degnan, J.H. Gurwitz.
Critical revision of the article for important intellectual content: B.A. Briesacher, J.M. Madden, F. Zhang, H. Fouayzi, D. Ross-Degnan, J.H. Gurwitz, S.B. Soumerai.
Final approval of the article: J.M. Madden, F. Zhang, H. Fouayzi, D. Ross-Degnan, J.H. Gurwitz, S.B. Soumerai.
Provision of study materials or patients: S.B. Soumerai.
Statistical expertise: B.A. Briesacher, F. Zhang, H. Fouayzi.
Obtaining of funding: J.M. Madden, D. Ross-Degnan, S.B. Soumerai.
Administrative, technical, or logistic support: B.A. Briesacher, J.M. Madden, S.B. Soumerai.
Collection and assembly of data: J.M. Madden, S.B. Soumerai.
Briesacher BA, Madden JM, Zhang F, Fouayzi H, Ross-Degnan D, Gurwitz JH, et al. Did Medicare Part D Affect National Trends in Health Outcomes or Hospitalizations?: A Time-Series Analysis. Ann Intern Med. 2015;162:825-833. doi: 10.7326/M14-0726
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Published: Ann Intern Med. 2015;162(12):825-833.
Medicare Part D increased economic access to medications, but its effect on population-level health outcomes and use of other medical services remains unclear.
To examine changes in health outcomes and medical services in the Medicare population after implementation of Part D.
Population-level longitudinal time-series analysis with generalized linear models.
Nationally representative sample of Medicare beneficiaries (n = 56 293 [unweighted and unique]) from 2000 to 2010.
Changes in self-reported health status, limitations in activities of daily living (ADLs) (ADLs and instrumental ADLs), emergency department visits and hospital admissions (prevalence, counts, and spending), and mortality. Medicare claims data were used for confirmatory analyses.
Five years after Part D implementation, no clinically or statistically significant reductions in the prevalence of fair or poor health status or limitations in ADLs or instrumental ADLs, relative to historical trends, were detected. Compared with trends before Part D, no changes in emergency department visits, hospital admissions or days, inpatient costs, or mortality after Part D were seen. Confirmatory analyses were consistent.
Only total population-level outcomes were studied. Self-reported measures may lack sensitivity.
Five years after implementation, and contrary to previous reports, no evidence was found of Part D's effect on a range of population-level health indicators among Medicare enrollees. Further, there was no clear evidence of gains in medical care efficiencies.
National Institute on Aging and the Agency for Healthcare Research and Quality.
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Hospital Medicine, Healthcare Delivery and Policy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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