Visual Impairment, Treatment and Effects on the Elderly

老年人视力障碍、治疗及其影响

• 批准号: 8149870
• 负责人: FRANK A SLOAN
• 金额: $ 30.67万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149870
• 关键词: Accounting; Address; Adherence; Admission activity; Affect; Age related macular degeneration; Argon; Blindness; Cardiovascular system; Caring; Cessation of life; Clinical; Cognitive; Complement; Complication; Complications of Diabetes Mellitus; Data; Databases; Diabetes Mellitus; Diabetic Retinopathy; Diagnosis; Diagnostic; Diagnostic Procedure; Diffusion; Drug Prescriptions; Effectiveness; Elderly; End stage renal failure; Expert Opinion; Eye; Eye diseases; Guidelines; Health; Health Services; Heart Diseases; Hip Fractures; Individual; Injection of therapeutic agent; Intervention; Kidney Diseases; Laser Surgery; Lasers; Light Coagulation; Longevity; Low-Level Laser Therapy; Macular degeneration; Medicare; Medicare claim; Mental Depression; Methods; Monitor; Morals; Neuropathy; Nursing Homes; Older Population; Operative Surgical Procedures; Outcome; Pattern; Personal Health Services; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Photochemotherapy; Physicians; Practice Guidelines; Process; Production; Productivity; Randomized Controlled Trials; Recommendation; Research; Retinal Detachment; Retirement; Risk; Role; Running; Sampling; Services; Severities; Social Welfare; Specialist; Steroids; Stroke; Surveys; Technology; Testing; Therapeutic; Therapeutic Intervention; Therapeutic procedure; Time; Vision; Visit; Visual; Visual impairment; Vital Statistics; Vitrectomy; Vitreous Hemorrhage; age related; base; beneficiary; bevacizumab; cerebrovascular; comparative effectiveness; cost; cost effectiveness; diabetic; diet and exercise; discounting; effective therapy; falls; hazard; improved; innovation; laser photocoagulation; macular edema; new technology; preference; proliferative diabetic retinopathy; treatment effect

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.

描述（由申请人提供）：这项为期3年的研究有3个特定目的：（1）研究主要眼疾的眼科护理诊断和治疗服务的纵向使用模式;（2）评估年龄相关性黄斑变性（AMD）眼科治疗的新创新和糖尿病眼病的更高强度治疗是否减少了视力丧失（全身和眼部）;和（3）评估使用情况、与指南的一致性以及心血管、脑血管和肾病结果。目的1研究双曲贴现作为不使用和扩散的新疗法治疗AMD的解释。目的2比较分析AMD治疗与糖尿病眼部治疗对视力及其他并发症的影响。目的3采用工具变量（IV）和控制函数方法研究诊断和治疗程序（包括处方药物）对心血管、脑血管和肾病结局的影响。为了补充IV分析，本研究调查的过程中选择到护理，评估的作用，如临床，人口统计学和财务因素的选择。将使用的国家纵向数据库包括：1991-2010年医疗保险5%索赔数据与生命统计信息合并; 1993-2008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; 1991-2009年医疗保险当前受益人调查数据也与医疗保险的行政信息合并。 公共卫生相关性：这项研究提供了有关个人使用Medicare承保服务的原因的重要信息。新的和有前途的治疗年龄相关性黄斑变性已被开发，但其对长期视力结果和相关并发症的影响，在全国范围内仍有待证明。我们的研究将提供有关这些问题的最新国家证据。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）主要眼部疾病和（2）诊断为糖尿病的患者的健康状况。