Parkinson Disease Disparities and Outcomes

帕金森病的差异和结果

• 批准号: 8423482
• 负责人: Allison Willis
• 金额: $ 16.47万
• 依托单位: WASHINGTON UNIVERSITY
• 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 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8423482
• 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. PUBLIC HEALTH RELEVANCE: 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. Preliminary data from our group suggests that there are disparities in treatment and outcomes in PD. The goal of this proposal is to identify how other medical illnesses (comorbid diseases) affects the health care people with PD receive, and the health outcomes they experience.

描述（申请人提供）：帕金森病（PD）是一种常见的老年人神经退行性疾病，以运动、认知、精神和自主神经特征为特征，目前尚无治愈方法。我们的初步数据表明，在帕金森病中接受神经科医师护理的情况存在种族和性别差异，定期神经科医师护理与帕金森病相关疾病的住院率降低和生存率提高有关。对这些关联的解释缺乏，并且成为帕金森病管理和生存领域取得进展的关键障碍。该项目有三个目标。第一个目标是候选人使用旨在检查共病疾病如何影响 PD 治疗差异和临床结果的多水平研究。第二个目标是为候选人提供一种获得人口科学、卫生服务和健康结果研究方面的教学培训的机制。最后，第三个是 候选人将接受结果和观察研究方法方面的密集指导，这将使她能够作为一名独立资助的调查员继续在健康差异、结果和行为研究领域工作。为了实现这些目标，候选人计划对 130,000 名患有 PD 的受益人进行患者层面的调查，以检查共病状况对专家利用和患者结果的相对影响。具体目标将检验以下假设：1) 合并症对帕金森病的健康结果（住院和死亡）具有可测量的影响和不同的预后影响，2) 合并症的数量和严重程度的差异解释了观察到的治疗差异的一部分帕金森病，以及 3) 帕金森病的诊断将导致对常见疾病管理和预防性护理的推荐指南的遵守程度降低，并且还与风险增加相关可避免的健康后果。在未接受常规神经科医生护理的帕金森病病例中，必要的医疗护理未充分利用以及可避免结果的发生率最高。这些目标将通过使用现有完整的医疗保险医疗索赔数据对诊断患有帕金森病的医疗保险受益人进行回顾性队列研究来实现。考生将推导并验证 PD 特定合并症指数 (PDCI)。该研究计划的完成还将通过识别合并症和健康服务事件来产生可操作的观察数据，从而预测帕金森病的结果和健康事件，为以结果为中心的前瞻性试验奠定基础，从而改善帕金森病患者的管理并获得更好的结果。我是密苏里州圣路易斯华盛顿大学医学院的神经病学和运动障碍专家助理教授。我的短期职业目标是获得用于观察和结果研究的先进流行病学和准实验技术的技能，并对 PD 的共病、护理差异和结果之间的关系进行初步调查。我的长期职业目标是利用在我指导的职业发展奖励期间开发的技能来进行以患者为中心的结果和健康服务研究，并作为独立资助的研究者对 PD 结果进行前瞻性观察研究。为了实现这些目标，我组建了一个由结果研究、健康行为/健康服务研究和流行病学专家组成的多学科指导/咨询团队。我们共同设计了一项研究和职业发展计划，该计划利用我目前在行政数据研究方面的技能，以我的初步数据为基础，这些数据表明帕金森病的护理和生存存在差异，并提供人口健康研究科学研究的技能发展。因此，我将成为一名独特的跨学科研究人员，在结果衡量、健康差异、人口科学和空间分析方面拥有特定技能。我将获得必要的培训和经验，以领导干预措施的多学科研究，以减少疾病负担和护理差异，改善帕金森病的结果，并将这些专业知识协作应用于其他神经系统或神经退行性疾病。 公共卫生相关性：帕金森病 (PD) 是一种常见的老年人神经退行性疾病，其特征为运动、认知、精神和自主神经特征，且无法治愈。我们小组的初步数据表明，帕金森病的治疗和结果存在差异。该提案的目标是确定其他医疗疾病（共病）如何影响帕金森病患者接受的医疗保健以及他们所经历的健康结果。