Visual Impairment, Treatment and Effects on the Elderly

描述（由申请人提供）：本研究是一项竞争性续期申请，有三个目的：在目的1中，我们扩展了目前正在进行的老年人糖尿病视网膜病变（DR）、青光眼和年龄相关性黄斑变性（ARMD）眼科护理服务纵向使用研究，以纳入白内障。第1组将描述四种眼病治疗干预的使用趋势;评估青光眼、DR和ARMD治疗程序使用的决定因素，以及医疗保险定价政策在确定白内障手术率中的作用。目标2将扩展我们对视力保健实践指南的遵守情况及其对视力结果的影响的分析，以包括治疗服务的使用及其作为定期监测功能的生产率。我们增加了我们目前研究中未使用的其他结局指标，药物和其他治疗，更长的分析时间和新数据。在目标3中，我们评估了利用率、对指南的依从性、各种治疗干预的生产率以及与糖尿病（DM）相关的结局，而不是视网膜病变（例如，心脏病发作、中风和截肢）。将进一步制定和实施一个计量经济学框架，以评估定期监测和治疗的共同影响。这项为期四年的延长期的数据将来自1984-2005年的全国长期护理调查与医疗保险索赔和登记数据合并，医疗保险5%样本，以及来自老年人老龄化动态（AHEAD）和健康与退休调查（HRS）与医疗保险索赔合并的65岁以上的人，以及与医疗保险索赔合并的当前医疗保险受益人调查（MCBS）。这项为期四年的研究预计将发表十篇论文。

DESCRIPTION (provided by applicant): This study, which is a competing renewal application, has three aims: In Aim 1, we expand our current ongoing study of longitudinal use of eye care services among the elderly for diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD) to include cataract. Arm 1 will describe trends in use of therapeutic interventions for the four eye diseases; assess determinants of use of therapeutic procedures for glaucoma, DR, and ARMD, as well as the role of Medicare pricing policies in determining rates of cataract surgery. Aim 2 will extend our analysis of adherence with practice guidelines for vision care and its effects on visual outcomes to include use of therapeutic services, and their productivity as a function of regular monitoring. We add additional outcome measures not used in our current study, pharmaceutical as well as other therapies, longer time periods for analysis, and new data. In Aim 3, we assess utilization, adherence to guidelines, the productivity of various therapeutic interventions, and outcomes associated with diabetes mellitus (DM) other than retinopathy (e.g., heart attack, stroke, and amputation) for elderly persons with diabetes mellitus. An econometric framework for assessing joint effects of regular monitoring and treatment will be further developed and implemented. Data for this four-year extension will come from the National Long-Term Care Surveys merged with Medicare claims and enrollment data for 1984-2005, the Medicare 5% sample, and on persons aged 65+ from the Aging Dynamics of the Oldest-Old (AHEAD) and Health and Retirement Surveys (HRS) merged with Medicare claims, and the Current Medicare Beneficiary Survey (MCBS) merged with Medicare claims. Ten papers are anticipated for this four-year study.