VISUAL IMPAIRMENT, TREATMENT, AND EFFECTS ON THE ELDERLY

这项为期四年的研究有四个主要目标。(1)老年 糖尿病视网膜病变、青光眼和黄斑病变患者 退化-可导致视力严重受损的疾病， 失明--我们将分析使用眼科保健服务的决定因素， 以及是否有糖尿病/糖尿病视网膜病变的医疗保险受益人 和青光眼接受护理按照最低限度的眼睛护理过程 标准这些标准已作为指导方针分发给专业人员， 组织的在这个阶段，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？研究疾病患者接受治疗的比例 至少在最低限度的指导方针？保持许多因素不变， 这些疾病的治疗存在种族差异吗(2)我们将研究 这些疾病的纵向过程，在视觉和 一般功能状态--身体、认知--以及 在养老院里，还有生存我们将分析护理的影响， 视力和其他结果指标。我们的数据是独一无二的， 随访患者的时间长度和健康范围 监测成果。(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 私人承担。计划成本将包括视力和非视力的成本 服务在我们的框架内，项目成本和患者对指南的依从性 将共同决定。(4)我们将重复前两个的分析 糖尿病并发症的目的，而不是眼睛。我们还将 指定和评估医疗保险覆盖范围利用动态模型 糖尿病患者的服务-视力和非视力护理。主要 数据库将是1982-2001年的国家长期护理调查（NLTCS）， 与1982年至2001年的医疗保险索赔数据合并。11篇论文正在计划中。

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.