Relationship between Claims-Based Frailty Index and Eye Care Utilization among Medicare Beneficiaries with Glaucoma.
Relationship between Claims-Based Frailty Index and Eye Care Utilization among Medicare Beneficiaries with Glaucoma.
复制标题
青光眼医疗保险受益人基于索赔的虚弱指数与眼保健利用率之间的关系。
DOI：
10.1016/j.ophtha.2023.01.015
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发表时间：
2023
期刊：
影响因子：
13.7
通讯作者：
Zebardast,Nazlee
中科院分区：
文献类型：
--
作者：
Halawa,OmarA;Kang,Joyce;Parikh,AyushA;Oh,Gahee;Glynn,RobertJ;Friedman,DavidS;Kim,DaeHyun;Zebardast,Nazlee
目的确定不同虚弱程度的青光眼医疗保险受益人的眼科护理利用差异。设计回顾性队列研究。2014年7月1日前使用国际疾病分类代码确定的65岁以上青光眼患者的医疗保险按服务收费受益人。方法通过使用经验证的基于索赔的虚弱指数（范围，0-1），受益人被分类为非虚弱/虚弱前期（0-0.19），轻度虚弱（0.20-0.29）和中度至重度虚弱（≥ 0.30）。采用负二项回归分析来估计2014年7月1日至2016年12月31日期间按虚弱程度划分的眼保健利用的事件率比（IRR）。主要结果测量当前眼科检查和眼保健相关门诊访视的程序术语编码;眼保健相关住院和急诊（艾德）就诊;眼保健相关护理设施和家访就诊;视野（VF）和视网膜神经纤维层（RNFL）OCT测试;和选择性激光小梁成形术（SLT）和青光眼surgery.ResultsAmong 76 260 Medicare受益人与青光眼，平均年龄为78.9岁（标准差，7.8），女性受益人占60.5%，和78.7%的受益人自我认定为非西班牙裔白色。根据基于索赔的虚弱指数，79.5%的受益人是非虚弱/虚弱前期，17.1%为轻度虚弱，3.4%为中度至重度虚弱。中度至重度虚弱的受益人比非虚弱/虚弱前受益人更不可能有门诊就诊（IRR，0.85，95%置信区间[CI]，0.83-0.88）; VF检验（IRR，0.64，95% CI，0.60-0.67）; RNFL OCT检验（IRR，0.77，95% CI，0.73-0.81）;（IRR，0.74，95% CI，0.60-0.92）;青光眼手术（IRR，0.74，95% CI 0.55-0.99），调整年龄、性别、青光眼严重程度、种族和社会经济地位后。与非虚弱/虚弱前受益人相比，中度至重度虚弱受益人的住院/艾德就诊率更高（IRR，5.03，95% CI，2.36-10.71）和护理机构/家访接触（IRR，34.89，95%CI，14.82-82.13）。中度至重度虚弱的受益人在门诊环境中的眼科护理利用率较低，而在急诊环境中的利用率较高。这表明虚弱的患者可能会接受更少的疾病监测和更少的青光眼管理干预。财务披露专有或商业披露可在参考文献后找到。
PurposeTo determine differences in eye care utilization by frailty levels among Medicare beneficiaries with glaucoma.DesignRetrospective cohort study.ParticipantsMedicare fee-for-service beneficiaries over 65 years of age with glaucoma, identified using International Classification of Diseases codes before July 1, 2014.MethodsBy using a validated claims-based frailty index (range, 0–1), beneficiaries were classified as nonfrail/prefrail (0–0.19), mildly frail (0.20–0.29), and moderate-to-severely frail (≥ 0.30). Negative binomial regression analyses were used to estimate incident rate ratios (IRRs) of eye care utilization by frailty levels between July 1, 2014, and December 31, 2016.Main Outcome MeasuresCurrent Procedural Terminology codes for eye examinations and eye care–related office visits; eye care–related inpatient and emergency department (ED) encounters; eye care–related nursing facility and home-visit encounters; visual field (VF) and retinal nerve fiber layer (RNFL) OCT tests; and selective laser trabeculoplasties (SLTs) and glaucoma surgeries.ResultsAmong 76 260 Medicare beneficiaries with glaucoma, the mean age was 78.9 years (standard deviation, 7.8), female beneficiaries constituted 60.5%, and 78.7% of beneficiaries self-identified as non-Hispanic White. According to a claims-based frailty index, 79.5% of beneficiaries were nonfrail/prefrail, 17.1% were mildly frail, and 3.4% were moderate-to-severely frail. Moderate-to-severely frail beneficiaries were less likely than nonfrail/prefrail beneficiaries to have outpatient encounters (IRR, 0.85, 95% confidence interval [CI], 0.83–0.88); VF tests (IRR, 0.64, 95% CI, 0.60–0.67); RNFL OCT tests (IRR, 0.77, 95% CI, 0.73–0.81); SLT (IRR, 0.74, 95% CI, 0.60–0.92); and glaucoma surgery (IRR, 0.74, 95% CI 0.55–0.99), after adjusting for age, gender, glaucoma severity, race, and socioeconomic status. Compared with nonfrail/prefrail beneficiaries, moderate-to-severely frail beneficiaries had higher rates of inpatient/ED encounters (IRR, 5.03, 95% CI, 2.36–10.71) and nursing facility/home-visit encounters (IRR, 34.89, 95% CI, 14.82–82.13).ConclusionsCompared with nonfrail/prefrail Medicare beneficiaries with glaucoma, beneficiaries with moderate-to-severe frailty had lower rates of eye care utilization in the outpatient setting and higher rates of utilization in acute care settings. This suggests that frail patients may receive less disease monitoring and fewer interventions for their glaucoma management.Financial Disclosure(s)Proprietary or commercial disclosure may be found after the references.