Monitoring visual status: Why patients do or do not comply with practice guidelines
Monitoring visual status: Why patients do or do not comply with practice guidelines
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DOI：
10.1111/j.1475-6773.2004.00297.x
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发表时间：
2004-10-01
影响因子：
3.4
通讯作者：
Lee, PP
中科院分区：
文献类型：
--
作者：
Sloan, FA;Brown, DS;Lee, PP
目标。确定影响糖尿病(DM)或老年性黄斑变性(ARMD)患者遵守年度眼科检查指南的因素。数据来源/研究环境。从国家长期护理调查(NLTCS)中抽取的具有全国代表性的65岁以上个人的纵向样本，具有关联的1991年至1999年的医疗保险索赔记录。研究设计。从1991年到1999年，对医疗保险受益人进行了跟踪调查，除非干预死亡率。对所有索赔数据进行分析，以确定是否存在指示DM或ARMD诊断的ICD-9代码以及眼睛检查的性能。因变量是一个二元指标，用来衡量一个人在15个月的时间里是否进行了视力检查。对人口统计学、生活条件、补充保险、收入和其他影响眼科检查边际成本和收益的因素进行自变量评估，以确定不符合要求的原因。数据收集/提取方法。专家组数据是从1991年至1999年的索赔档案中创建的，与NLTCS主要调查结果的数据合并在一起。接受检查的可能性反映了感知到的好处，这些好处因患者特征(例如，教育程度、无痴呆症)和与就诊容易相关的因素而有所不同。非洲裔美国人接受检查的可能性比白人小得多。考试反映了多种因素。然而，考试概率的大部分变化仍然没有得到解释，使用中存在种族差异的原因也是如此。
Objective. To determine factors affecting compliance with guidelines for annual eye examinations for persons diagnosed with diabetes mellitus (DM) or age-related macular degeneration (ARMD).Data Sources/Study Setting. Nationally representative, longitudinal sample of individuals 65+ drawn from the National Long-Term Care Survey (NLTCS) with linked Medicare claims records from 1991 to 1999.Study Design. Medicare beneficiaries were followed from 1991 to 1999, unless mortality intervened. All claims data were analyzed for presence of ICD-9 codes indicating diagnosis of DM or ARMD and the performance of eye exams. The dependent variable was a binary indicator for whether a person had an eye exam or not during a 15-month period. Independent variables for demographics, living conditions, supplemental insurance, income, and other factors affecting the marginal cost and benefit of an eye exam were assessed to determine reasons for noncompliance.Data Collection/Extraction Methods. Panel data were created from claims files, 1991-1999, merged with data from the NLTCS.Principal Findings. The probability of having an exam reflected perceived benefits, which vary by patient characteristics (e.g., education, no dementia), and factors associated with the ease of visit. African Americans were much less likely to be examined than were whites.Conclusions. Having an exam reflects multiple factors. However, much of the variation in the probability of an exam remained unexplained as were reasons for the racial differences in use.