Visual Impairment, Treatment and Effects on the Elderly

描述(申请人提供)：这项为期3年的研究有3个具体目标：(1)考察主要眼病的眼睛保健诊断和治疗服务的纵向使用模式；(2)评估老年性黄斑变性(AMD)眼科治疗的新创新和糖尿病眼病(全身和眼部)更大强度的治疗是否减少了视力损失；以及(3)评估利用情况、对指南的遵从性以及心血管、脑血管和肾病的预后。目的1研究双曲线贴现作为AMD治疗新疗法未使用和扩散的解释。目的比较分析黄斑变性与糖尿病眼部治疗对视力及其他并发症的影响。目的3使用工具变量(IV)和对照函数方法，研究诊断和治疗程序，包括处方药，对心血管、脑血管和肾病预后的影响。为了补充IV分析，这项研究调查了选择护理的过程，评估了临床、人口和经济因素等可观测因素对选择的作用。将使用的全国性纵向数据库包括：1991-2010年间与重要统计信息合并的Medicare 5%索赔数据；1993-2008年间与Medicare索赔合并的Medicare受益人的健康和退休调查数据；1991-2009年间Medicare当前受益人调查数据也与Medicare的管理信息合并。 公共卫生相关性：这项研究提供了有关个人使用医疗保险覆盖服务的原因的重要信息。治疗老年性黄斑变性的新的有希望的治疗方法已经被开发出来，但它们对国家环境下长期视力结果和相关并发症的影响仍有待证实。我们的研究将提供有关这些问题的最新全国性证据。我们将记录适当使用推荐的护理和治疗程序是否会改善患有(1)主要眼病和(2)被诊断为糖尿病的人的健康结果。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: This study provides important information about reasons individuals use Medicare-covered services. New and promising treatments in age-related macular degeneration have been developed but their effects on long-run visual outcomes and associated complications in a national setting remain to be demonstrated. Our study will provide recent national evidence on these issues. We will document whether appropriate use of recommended care and therapeutic procedures leads to better health outcomes among persons with (1) major eye diseases and (2) diagnosed with diabetes mellitus.