Impact of routine eye care coverage on access to eye care and fall-related outcomes among low-income Medicare enrollees

常规眼保健覆盖范围对低收入医疗保险参保者获得眼保健和跌倒相关结果的影响

• 批准号: 10630226
• 负责人: Brandy Lipton
• 金额: $ 52.44万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10630226
• 关键词: Accident and Emergency department; Address; Adult; Age; Age related macular degeneration; Aging; Alzheimer' s disease related dementia; Behavioral Model; Black race; Caring; Cataract; Data; Data Sources; Databases; Devices; Diabetes Mellitus; Diagnosis; Elderly; Ethnic Origin; Eye; Eye diseases; Eyeglasses; Fee-for-Service Plans; Glass; Glaucoma; Health; Health Insurance; Health Services Accessibility; Hip Fractures; Hispanic; Individual; Insurance Coverage; Link; Low income; Measures; Medicaid; Medical Care Costs; Medicare; Medicare claim; Memory Loss; Methods; Mission; Modeling; Morbidity - disease rate; National Health Interview Survey; Outcome; Patient Self-Report; Personal Satisfaction; Policies; Population; Prevalence; Price; Public Health; Qualifying; Quality of life; Quasi-experiment; Race; Refractive Errors; Reporting; Research; Research Personnel; Risk Reduction; Role; Services; Subgroup; Surveys; Testing; United States National Institutes of Health; Variant; Vision; Visit; Visual impairment; Woman; Work; beneficiary; dementia risk; disability; dual eligible; experience; fall injury; fall risk; falls; fear of falling; federal policy; health service use; high risk population; human old age (65+); improved; innovation; medically necessary care; men; mortality; ophthalmic examination; programs; public health insurance; sex; trend

PROJECT SUMMARY/ABSTRACT Vision problems are prevalent among older adults, with about 92% of Medicare enrollees ages 65 and older using vision correction, and 39% of Medicare enrollees who use vision correction reporting trouble seeing even with eyeglasses. Visual impairment is associated with increased morbidity and mortality, including an increased risk of falls and hip fractures. While most fee-for-service Medicare enrollees do not have coverage for routine eye exams and glasses, some low-income Medicare enrollees have comprehensive vision coverage if they qualify for full Medicaid benefits (“dual eligibles”) and reside in a state with a Medicaid program that covers vision services. The objective of this proposal is to use quasi-experimental methods to estimate the effect of Medicaid coverage of routine eye exams and glasses on eye care access and fall-related outcomes among dual eligibles during 2000-2019. The central hypothesis is that coverage of vision services will increase eye care visits and reduce the risk of falling by improving vision. The central hypothesis will be tested by pursuing three specific aims: 1) to examine the effects of Medicaid vision benefits on measures of access to eye care and vision including eye care visits, unmet needs for glasses, out-of-pocket spending on routine eye care, self-reported trouble seeing, functional limitations due to vision, and Medicare claims-based measures of past-year treatment for glaucoma, cataracts, and age-related macular degeneration; 2) to examine the effects of Medicaid vision benefits on fall-related outcomes including self-reported falls, fall-related injuries, and activity limitations due to fear of falling and administrative measures of treatment for falls; and 3) to evaluate the effects of Medicaid vision benefits by sex, race and ethnicity, diabetes diagnosis, and by Alzheimer’s disease, related dementias, and memory loss. The research proposed in this application is innovative because it will use several complementary data sources including linked survey and administrative claims data to examine measures of eye care access and fall-related outcomes, compile a comprehensive database of Medicaid vision benefit policies over a more than 20 year period to be shared with researchers, combine a quasi-experimental approach with a 9 year panel of individual longitudinal data, and apply newly developed methods to address variation in the timing of state policy changes. The proposed research is significant because the number of adults ages 65 and older is projected to more than double over the next 40 years. Correspondingly, the prevalence of vision problems and injurious falls is likely to increase significantly over this period. The proposed aims will produce the first estimates of the effects of Medicaid vision benefits on eye care access and fall-related outcomes among dual eligibles. The public health impact of this research will be to provide critical, timely, and policy relevant evidence on the effects of increased access to vision care among older adults and the role of public health insurance.

项目摘要/摘要 视力问题在老年人中普遍存在，大约92％的Medicare注册了65岁以上 使用视力校正，以及39％ 与眼镜。视觉障碍与发病率和死亡率的增加有关，包括 增加跌倒和髋部骨折的风险。虽然大多数支付费用的医疗保险注册都没有保险 对于常规的眼科检查和眼镜，一些低收入的医疗保险注册有全面的视力覆盖范围 如果他们有资格获得全部医疗补助福利（“双重资格”），并居住在一个医疗补助计划的州中 涵盖视觉服务。该建议的目的是使用准实验方法来估计 医疗补助覆盖常规眼检查和眼镜对眼部护理的影响和与跌倒有关的结果 在2000年至2019年的双重资格中。中心假设是，视觉服务的覆盖范围将增加 通过改善视力来访问并降低跌落的风险。中心假设将通过 追求三个具体目标：1）检查医疗补助视觉益处对访问措施的影响 眼保健和视力，包括眼保健探访，对眼镜的未满足需求，日常眼睛的自付支出 护理，自我报告的麻烦查看，由于视觉引起的功能限制以及基于Medicare索赔的措施 青光眼，白内障和与年龄相关的黄斑变性的过去一年治疗； 2）检查效果 医疗补助视力对秋天相关的结果的好处，包括自我报告的跌倒，与跌倒有关的伤害和活动 由于担心下降和跌倒治疗的行政措施而造成的局限性； 3）评估 性别，种族和种族，糖尿病诊断和阿尔茨海默氏病的影响，医疗补助视力受益的影响， 相关的痴呆症和记忆丧失。本应用程序中提出的研究具有创新性，因为它将 使用几个完整的数据源，包括链接的调查和行政索赔数据来检查 眼保健访问和与跌倒有关的结果的度量，编译了Medicaid Vision的全面数据库 在20年以上的时间内与研究人员共享的福利政策，结合准实验 使用为期9年的单个纵向数据进行接近，并应用新开发的方法来解决 国家政策变化的时间变化。拟议的研究很重要，因为 在未来40年中，65岁及65岁以上的成年人预计将增加两倍以上。相应地， 在此期间，视力问题和有害跌倒的患病率可能会大大增加。这 拟议的目标将对医疗补助视力益处对眼部护理访问的影响进行首次估计和 双重资格中与跌倒有关的结果。这项研究的公共卫生影响将是提供关键， 及时和政策有关的证据，证明老年人增加视力护理的影响以及 公共卫生保险的作用。