VISUAL IMPAIRMENT, TREATMENT, AND EFFECTS ON THE ELDERLY

描述：这项为期四年的研究有四个主要目标。(1)长者 糖尿病患者糖尿病视网膜病变、青光眼和黄斑 变性--可导致视力严重受损的疾病 失明--我们将分析眼科护理服务利用的决定因素， 以及医疗保险受益人是否患有糖尿病/糖尿病视网膜病变 和青光眼按照最低限度的眼睛护理程序接受护理 标准。这些标准已由专业人士作为指南进行传播 组织。在这个阶段，我们将解决这些问题。数据如何在 患者自我诊断报告与医生诊断报告的比较 诊断结果？患有研究性疾病的人接受护理的比例是多少？ 至少在指导方针的最低水平上？保持许多因素不变，是 这些疾病的治疗有种族差异吗？(2)我们将研究 这些疾病的纵向病程，以视力和 一般功能状态--身体、认知--以及在位置方面 在疗养院，和生存。我们将分析护理对以下方面变化的影响 愿景和其他结果衡量标准。我们的数据在以下两方面都是独一无二的 在健康范围内对患者进行跟踪的时间长度 结果受到监控。(3)我们将评估糖尿病、青光眼和 黄斑变性对医疗保险和医疗补助计划总成本和成本的影响 私人招致的。计划成本将包括愿景成本和非愿景成本 服务。在我们的框架中，计划成本和患者对指南的遵从性 将由双方共同决定。(4)我们将复制前2项的分析 目的：治疗糖尿病眼部以外的并发症。我们还将 确定和估计医疗保险覆盖范围的动态利用模型 糖尿病患者的服务--包括视力和非视力护理。主 数据库将是1982-2001年全国长期护理调查(NLTCS)， 与1982-2001年的医疗保险索赔数据合并。计划发表11篇论文。

DESCRIPTION: This four-year study has four major objectives. (1) For elderly persons with diabetes mellitus diabetic retinopathy, glaucoma, and macular degeneration -- diseases that can cause serious impairments to vision and blindness -- we will analyze determinants of utilization of eye care services, and whether or not Medicare beneficiaries with diabetes/diabetic retinopathy and glaucoma receive care in accordance with minimal process of eye care standards. Such standards have been disseminated as guidelines by professional organizations. In this phase, we will address these issues. How do data on patient self-report of diagnosis compare with those obtained from physicians' diagnoses? What proportions of persons with the study diseases receive care at least at the minimum level of guidelines? Holding many factors constant, are there racial differences in treatments for these diseases? (2) We will study the longitudinal course of these diseases, measured in terms of visual and general functional status -- physical, cognitive -- and in terms of placement in a nursing home, and survival. We will analyze effects of care on changes in vision and the other outcome measures. Our data are unique both in terms of the length of time over which patients are followed and in the range of health outcome monitored. (3) We will assess the impact of diabetes, glaucoma, and macular degeneration on total Medicare and Medicaid program cost and on costs privately incurred. Program cost will include cost of vision and non-vision services. In our framework, program cost and patient adherence to guidelines will be jointly determined. (4) We will replicate the analysis of the first 2 objectives for complications of diabetes other than for eyes. We will also specify and estimate a dynamic model of utilization of Medicare-covered services by persons with diabetes -- both vision and nonvision care. The main database will be the National Long-Term Care Survey (NLTCS) for 1982-2001, merged with Medicare claims data for 1982-2001. Eleven papers are planned.