Visual Impairment, Treatment and Effects on the Elderly

描述(申请人提供)：这项研究是一项竞争性的续签申请，有三个目标：在目标1中，我们扩展了我们目前正在进行的关于糖尿病视网膜病变(DR)、青光眼和年龄相关性黄斑变性(ARMD)老年人眼部护理服务纵向使用的研究，将白内障包括在内。ARM 1将描述四种眼病治疗干预措施的使用趋势；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方面的作用。目标2将扩展我们对视力护理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力。我们增加了目前研究中没有使用的其他结果测量方法、药物和其他疗法、更长的分析时间段和新的数据。在目标3中，我们评估了老年糖尿病患者的利用率、对指南的遵守情况、各种治疗干预措施的效率，以及与视网膜病变(如心脏病发作、中风和截肢)以外的糖尿病(DM)相关的结果。将进一步制定和实施评估定期监测和治疗联合影响的计量经济学框架。此次延期四年的数据将来自与1984-2005年的联邦医疗保险申领和登记数据合并的全国长期护理调查、联邦医疗保险5%的样本、来自与联邦医疗保险索赔合并的老年动态(AHEAD)和健康和退休调查(HRS)的65岁以上人群的数据，以及当前的联邦医疗保险受益人调查(MCBS)与联邦医疗保险索赔合并的数据。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.