Visual Impairment, Treatment and Effects on the Elderly

描述（由申请人提供）：这项为期3年的研究有3个具体目的：(1)检查主要眼病的眼科护理诊断和治疗服务的纵向使用模式；(2)评估视力丧失是否已经通过眼部治疗的创新和糖尿病性眼病（包括全身和眼部）的更大治疗强度而减少；(3)评估用药情况、指南的依从性以及心脑血管和肾病的预后。目的1研究双曲贴现作为不使用和扩散治疗AMD的新疗法的解释。Aim 2对AMD治疗和糖尿病眼治疗对视力和其他并发症的效果进行比较效果分析。目的3使用工具变量（IV）和控制函数方法研究诊断和治疗程序（包括处方药）对心、脑血管和肾病结果的影响。为了补充IV分析，本研究调查了选择护理的过程，评估了临床、人口统计学和财务因素等可观察因素对选择的影响。将使用的全国性纵向数据库包括：1991-2010年医疗保险5%索赔数据与生命统计信息合并；1993-2008年医疗保险受益人健康和退休调查数据与医疗保险索赔合并；医疗保险当前受益人调查数据也与1991-2009年医疗保险的行政信息合并。

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.