Visual Impairment, Treatment and Effects on the Elderly

工作概要 这项为期3年的研究有3个具体目标：（1）检查眼科诊断和治疗的纵向使用模式， 主要眼疾的治疗服务;（2）评估新的治疗方法是否减少了视力丧失 年龄相关性黄斑变性（AMD）眼部治疗的创新， 糖尿病性眼病（包括全身性和眼部）;（3）评估使用情况，是否符合指南，以及 心血管、脑血管和肾病结局。目的1研究双曲贴现作为一种 解释不使用和扩散治疗AMD的新疗法。目标2执行比较 AMD治疗和糖尿病眼治疗对视力和其他影响的有效性分析 并发症目的3调查诊断和治疗程序的影响，包括处方药， 使用工具变量（IV）和对照， 函数方法为了补充IV分析，本研究调查了选择护理的过程， 评估临床、人口统计学和财务因素等可观察因素对选择的作用。国家， 使用的纵向数据库包括：医疗保险5%索赔数据与生命统计信息合并 1991-2010年;医疗保险受益人的健康和退休调查数据与医疗保险索赔合并 1993-2008年;医疗保险当前受益人调查数据也与来自 医疗保险，1991-2009年。

Summary of work This 3-year study has 3 specific aims: (1) Examine patterns of longitudinal use of eye care diagnostic and therapeutic services for major eye diseases; (2) Assess whether visual loss has been reduced by new innovations in ocular therapy for age-related macular degeneration (AMD) and greater intensity of therapy in diabetic eye diseases (both systemic and ocular); and (3) Assess utilization, conformance with guidelines, and cardiovascular, cerebrovascular, and nephropathy outcomes. Aim 1 investigates hyperbolic discounting as an explanation of nonuse and diffusion of new therapies for treatment of AMD. Aim 2 performs comparative effectiveness analysis of effects of AMD therapies and diabetic eye therapies on visual and other complications. Aim 3 investigates effects of diagnostic and therapeutic procedures, including prescribed drugs, on cardiovascular, cerebrovascular, and nephropathy outcomes using instrumental variable (IV) and control function methods. To complement the IV analysis, this study investigates the process of selection into care, assessing roles of such observables as clinical, demographic and financial factors on selection. National, longitudinal data bases to be used include: Medicare 5% claims data merged with vital statistics information from 1991-2010; Health and Retirement Survey data on Medicare beneficiaries merged with Medicare claims for 1993-2008; and Medicare Current Beneficiary Survey data also merged with administrative information from Medicare, 1991-2009.