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.

项目概要/摘要 视力问题在老年人中普遍存在，约 92% 的 Medicare 参保者年龄在 65 岁及以上 使用视力矫正，并且 39% 使用视力矫正的 Medicare 参保者报告甚至有视力障碍 视力障碍与发病率和死亡率增加有关，包括 跌倒和髋部骨折的风险增加，而大多数付费医疗保险参与者没有保险。 对于常规眼科检查和眼镜，一些低收入医疗保险参与者拥有全面的视力保险 如果他们有资格享受全额医疗补助福利（“双重资格”）并且居住在有医疗补助计划的州，并且 该提案的目标是使用准实验方法来估计视觉服务。 医疗补助覆盖常规眼科检查和眼镜对眼科护理获取和跌倒相关结果的影响 2000 年至 2019 年期间，双重资格人群的中心假设是视力服务的覆盖范围将会增加。 进行眼部护理并通过改善视力来降低跌倒风险将通过以下方式进行检验。 追求三个具体目标：1）研究医疗补助愿景福利对获得医疗服务的措施的影响 眼保健和视力，包括眼保健就诊、未满足的眼镜需求、常规眼科自付费用 护理、自我报告的视力障碍、视力引起的功能限制以及基于医疗保险索赔的措施 过去一年对青光眼、白内障和年龄相关性黄斑变性的治疗；2) 检查效果； 的医疗补助视力受益于跌倒相关结果，包括自我报告的跌倒、跌倒相关伤害和活动 由于担心跌倒而造成的限制以及跌倒治疗的管理措施；以及 3) 评估 医疗补助视力受益对性别、种族和民族、糖尿病诊断以及阿尔茨海默病的影响， 相关的痴呆症和记忆丧失。本申请中提出的研究具有创新性，因为它将 使用多个补充数据源，包括关联调查和行政索赔数据来检查 眼保健服务获取和跌倒相关结果的衡量标准，编制医疗补助视力综合数据库 与研究人员共享超过 20 年期间的福利政策，结合准实验 方法采用 9 年个体纵向数据面板，并应用新开发的方法来解决 国家政策变化时间的变化很重要，因为数量众多。 未来 40 年，65 岁及以上的成年人预计将增加一倍以上。 在此期间，视力问题和跌倒受伤的发生率可能会显着增加。 拟议的目标将对医疗补助视力福利对眼保健服务的影响进行初步估计 这项研究对公共健康的影响将是提供关键的、 关于增加老年人和老年人获得视力保健机会的影响的及时和政策相关的证据 公共健康保险的作用。