Parkinson Disease Disparities and Outcomes

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DESCRIPTION (provided by applicant): Parkinson Disease (PD) is a common neurodegenerative disease of the elderly characterized by motor, cognitive, psychiatric and autonomic features, for which there is no cure. Our preliminary data suggest that there are racial and gender disparities in the utilization of neurologist care in PD, and that regular neurologist care is associated with lower hospitalization rates for PD related illnesses and improved survival. Explanations for these associations are lacking and serve as a critical barrier to progress in the field of Parkinson Disease management and survivorship. This project has three objectives. The first objective is for the candidate to use a multilevel study designed to examine how comorbid disease contributes to treatment disparities and clinical outcomes in PD. The second objective is to provide the candidate with a mechanism by which to obtain didactic training in population science, health services and health outcomes research. Finally, the third is for the candidate to receive intense mentoring in outcomes and observational research methods, which will allow her to continue work in the field of health disparities, outcomes and behavior research as an independently funded investigator. To achieve these objectives, the candidate plans to perform a patient level investigation of 130,000 beneficiaries with incident PD to examine the relative contribution of comorbid conditions on specialist utilization and patient outcomes. The specific aims will test the following hypotheses: 1) Comorbid illnesses have a measurable effect and varying prognostic impact on health outcomes (hospitalization and death) in PD, 2) Differences in the number and severity of comorbidities explain a proportion of the observed treatment disparities in Parkinson Disease, and 3) A diagnosis of Parkinson Disease will be associated with reduced adherence to recommended guidelines for management of common diseases and preventive care and will also be associated with an increased risk of avoidable health outcomes. Underuse of medically necessary care and the incidence of avoidable outcomes will be greatest among PD cases who do not receive regular neurologist care. These aims will be achieved by performing a retrospective cohort study of Medicare beneficiaries diagnosed with Parkinson Disease using existing complete Medicare medical claims data. The candidate will derive and validate a PD-specific comorbidity index (PDCI). The completion of this research plan will also result in actionable observational data by identifying comorbidities and health service events which predict outcomes and health events in PD, setting the stage for prospective outcome-centered trials that will lead to improved management of PD patients and better outcomes. I am an Assistant Professor of Neurology and Movement Disorders Specialist at Washington University School of Medicine in St. Louis, MO. My short-term career goals are to acquire skills in advanced epidemiological and quasi-experimental techniques used in observational and outcomes research and to perform initial investigations of the relationships between comorbidity, care disparities and outcomes in PD. My long term career goals are to use the skills developed during my mentored career development award period to perform patient-centered outcomes and health services research and to conduct prospective observational studies of PD outcomes as an independently funded investigator. To achieve these goals, I have assembled a multidisciplinary mentoring/advisory team with experts in outcomes research, health behavior/ health services research and epidemiology. Together, we have designed a research and career development plan that utilizes my current skills in administrative data research, builds on my preliminary data which suggest that there are disparities in PD care and survival, and provides skill development in population science of health research. As a result, I will emerge as a uniquely cross-trained researcher with specific skills in outcome measurement, health disparities, population science and spatial analysis. I will have acquired the training and experience necessary to lead multi-disciplinary investigations of interventions to reduce disease burden and disparities in care, to improve outcomes in PD and to provide collaborative application of this expertise to other neurological or neurodegenerative diseases.