Visual Impairment, Treatment and Effects on the Elderly

工作总结 这项为期3年的研究有3个具体目标：(1)检查眼睛护理诊断和诊断的纵向使用模式 主要眼科疾病的治疗服务；(2)评估新技术是否减少了视力损失 老年性黄斑变性(AMD)眼科治疗的创新和更高的治疗强度 糖尿病眼病(包括全身和眼部疾病)；和(3)评估利用率，遵守指南，以及 心血管、脑血管和肾病结果。AIM 1将双曲贴现作为一种 解释治疗AMD的新疗法的不使用和推广。AIM 2进行比较 老年性黄斑变性与糖尿病眼部治疗对视力及其他影响的疗效分析 并发症。目标3调查诊断和治疗程序的效果，包括处方药， 使用工具变量(IV)和对照对心脑血管和肾病预后的影响 函数方法。为了补充IV分析，本研究调查了选择护理的过程， 评估临床、人口学和财务因素等观察指标在选择中的作用。全国性的， 将使用的纵向数据库包括：与生命统计信息合并的Medicare 5%索赔数据 1991-2010年；医疗保险受益人的健康和退休调查数据与医疗保险索赔合并 1993-2008年；Medicare当前受益人调查数据也与来自 医疗保险，1991-2009年。

Summary of work 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.