Parkinson Disease Disparities and Outcomes

帕金森病的差异和结果

• 批准号: 8540463
• 负责人: Allison Willis
• 金额: $ 16.47万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8540463
• 关键词: Adherence; Affect; Anemia; Behavior; Caring; Categories; Cessation of life; Chronic Obstructive Airway Disease; Clinical; Cognitive; Cohort Studies; Comorbidity; Comorbidity Index; Congestive Heart Failure; Control Groups; Controlled Study; Data; Demographic Factors; Development; Development Plans; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Disease Outcome; Elderly; Epidemiology; Event; Funding; Gender; Geographic Factor; Goals; Guidelines; Health; Health Services; Health Services Research; Health behavior; Healthcare; Hospitalization; Hyperlipidemia; Hypertension; Incidence; Individual; Intervention; Investigation; K-Series Research Career Programs; Lead; Measurable; Measurement; Medical; Medicare; Mental Depression; Mentors; Morbidity - disease rate; Motor; Movement Disorders; Myocardial Infarction; Neurodegenerative Disorders; Neurologist; Neurology; Newly Diagnosed; Observational Study; Outcome; Outcomes Research; Outcomes and Health Services Research; Parkinson Disease; Patient-Focused Outcomes; Patients; Physicians; Population Sciences; Prevalence; Preventive; Quality of Care; Quality of life; Relative (related person); Research; Research Design; Research Methodology; Research Personnel; Research Proposals; Risk; Selection Bias; Severities; Socioeconomic Factors; Specialist; Staging; Statistical Methods; Subgroup; Techniques; Testing; Time; Training; Treatment outcome; Universities; Washington; Work; base; beneficiary; burden of illness; career; career development; comparative; design; disease diagnosis; experience; health care quality; health disparity; improved; indexing; malignant breast neoplasm; medical schools; medical specialties; medically necessary care; mortality; multidisciplinary; nervous system disorder; policy implication; professor; prognostic; prospective; research and development; research study; skills; statistics; survivorship

DESCRIPTION (provided by applicant): Parkinson Disease (PD) is a common neurodegenerative disease of the elderly characterized by motor, cognitive, psychiatric and autonomic features, for which there is no cure. Our preliminary data suggest that there are racial and gender disparities in the utilization of neurologist care in PD, and that regular neurologist care is associated with lower hospitalization rates for PD related illnesses and improved survival. Explanations for these associations are lacking and serve as a critical barrier to progress in the field of Parkinson Disease management and survivorship. This project has three objectives. The first objective is for the candidate to use a multilevel study designed to examine how comorbid disease contributes to treatment disparities and clinical outcomes in PD. The second objective is to provide the candidate with a mechanism by which to obtain didactic training in population science, health services and health outcomes research. Finally, the third is for the candidate to receive intense mentoring in outcomes and observational research methods, which will allow her to continue work in the field of health disparities, outcomes and behavior research as an independently funded investigator. To achieve these objectives, the candidate plans to perform a patient level investigation of 130,000 beneficiaries with incident PD to examine the relative contribution of comorbid conditions on specialist utilization and patient outcomes. The specific aims will test the following hypotheses: 1) Comorbid illnesses have a measurable effect and varying prognostic impact on health outcomes (hospitalization and death) in PD, 2) Differences in the number and severity of comorbidities explain a proportion of the observed treatment disparities in Parkinson Disease, and 3) A diagnosis of Parkinson Disease will be associated with reduced adherence to recommended guidelines for management of common diseases and preventive care and will also be associated with an increased risk of avoidable health outcomes. Underuse of medically necessary care and the incidence of avoidable outcomes will be greatest among PD cases who do not receive regular neurologist care. These aims will be achieved by performing a retrospective cohort study of Medicare beneficiaries diagnosed with Parkinson Disease using existing complete Medicare medical claims data. The candidate will derive and validate a PD-specific comorbidity index (PDCI). The completion of this research plan will also result in actionable observational data by identifying comorbidities and health service events which predict outcomes and health events in PD, setting the stage for prospective outcome-centered trials that will lead to improved management of PD patients and better outcomes. I am an Assistant Professor of Neurology and Movement Disorders Specialist at Washington University School of Medicine in St. Louis, MO. My short-term career goals are to acquire skills in advanced epidemiological and quasi-experimental techniques used in observational and outcomes research and to perform initial investigations of the relationships between comorbidity, care disparities and outcomes in PD. My long term career goals are to use the skills developed during my mentored career development award period to perform patient-centered outcomes and health services research and to conduct prospective observational studies of PD outcomes as an independently funded investigator. To achieve these goals, I have assembled a multidisciplinary mentoring/advisory team with experts in outcomes research, health behavior/ health services research and epidemiology. Together, we have designed a research and career development plan that utilizes my current skills in administrative data research, builds on my preliminary data which suggest that there are disparities in PD care and survival, and provides skill development in population science of health research. As a result, I will emerge as a uniquely cross-trained researcher with specific skills in outcome measurement, health disparities, population science and spatial analysis. I will have acquired the training and experience necessary to lead multi-disciplinary investigations of interventions to reduce disease burden and disparities in care, to improve outcomes in PD and to provide collaborative application of this expertise to other neurological or neurodegenerative diseases.

描述（由申请人提供）：帕金森病（PD）是一种常见的老年人疾病，其特征是运动，认知，精神病和自主性特征，无法治愈。我们的初步数据表明，在PD中使用神经科医生护理中存在种族和性别差异，并且定期的神经科医生护理与PD相关疾病的住院率较低并提高了生存率。这些协会的解释缺乏，并成为帕金森氏病管理和生存领域进步的关键障碍。该项目有三个目标。第一个目的是让候选人使用一项多层次研究，以研究合并症如何促进PD治疗差异和临床结果。第二个目标是为候选人提供一种在人群科学，卫生服务和健康成果研究中进行教学培训的机制。最后，第三是 为了使候选人在成果和观察研究方法中获得强烈的指导，这将使她能够继续在健康差异，成果和行为研究领域工作，成为独立资助的研究者。为了实现这些目标，候选人计划对130,000名受益人进行患者水平调查，以检查合并症条件对专业利用和患者结果的相对贡献。具体目的将检验以下假设：1）合并症具有可测量的作用，并且对健康结果（住院和死亡）的预后影响有所不同，PD），2）合并症的数量和严重程度的差异与帕克森病的诊断相关的诊断的合并症的数量和严重程度的差异解释了帕克森病的诊断，以及3）帕克森病的诊断，3）和预防保健，也将与可避免健康结果的风险增加有关。在不接受定期神经科医生护理的PD病例中，最大程度的医疗护理和可避免结果的发生率最大。这些目标将通过使用现有完整的Medicare医疗索赔数据进行诊断为帕金森氏病的医疗保险受益人进行回顾性队列研究。候选人将得出并验证PD特异性合并症指数（PDCI）。该研究计划的完成还将通过确定合并症和卫生服务事件来预测PD中的结果和健康事件，从而为预期以结果为中心的试验奠定了基础，从而导致PD患者的管理和更好的结果。我是密苏里州圣路易斯华盛顿大学医学院神经病学和运动障碍专家的助理教授。我的短期职业目标是获得在观察和成果研究中使用的高级流行病学和准实验技术的技能，并对PD合并症，护理差异和结果之间的关系进行初步研究。我的长期职业目标是利用我指导的职业发展奖中开发的技能来执行以患者为中心的结果和卫生服务研究，并作为独立资助的研究者对PD成果的前瞻性观察研究。为了实现这些目标，我与成果研究，健康行为/健康服务研究和流行病学专家组合了一个多学科指导/咨询团队。我们共同设计了一项研究和职业发展计划，该计划利用我当前的行政数据研究技能，建立在我的初步数据的基础上，这表明PD护理和生存存在差异，并提供了健康研究人群科学的技能发展。结果，我将成为一名具有独特的交叉训练研究人员，具有特定的成果测量，健康差异，人口科学和空间分析的技能。我将获得必要的培训和经验，以领导对干预措施的多学科调查，以减轻疾病负担和护理差异，以改善PD的预后，并为其他神经或神经退行性疾病提供此专业知识的协作应用。