Parkinson Disease Disparities and Outcomes

描述（由申请人提供）：帕金森病（PD）是一种常见的老年神经退行性疾病，以运动、认知、精神和自主神经功能为特征，目前尚无治愈方法。我们的初步数据表明，在PD患者中神经科医生治疗的利用率存在种族和性别差异，定期神经科医生治疗与PD相关疾病的住院率降低和生存率提高相关。缺乏对这些关联的解释，这是帕金森病管理和生存领域取得进展的关键障碍。该项目有三个目标。第一个目标是候选人使用多水平研究，旨在检查共病疾病如何影响PD的治疗差异和临床结局。第二个目标是为候选人提供一种机制，使其获得人口科学、保健服务和保健成果研究方面的教学培训。最后，第三个是 候选人在结果和观察研究方法方面接受密集的指导，这将使她能够作为独立资助的研究人员继续在健康差异，结果和行为研究领域工作。为了实现这些目标，候选人计划对130，000名患有PD事件的受益人进行患者水平调查，以检查共病条件对专家利用和患者结局的相对贡献。具体目标将检验以下假设：1）共病对健康结果有可测量的影响和不同的预后影响（住院和死亡），2）合并症的数量和严重程度的差异解释了帕金森病中观察到的治疗差异的比例，和3）帕金森病的诊断将与对常见疾病管理和预防性护理的推荐指南的依从性降低相关，并且还将与帕金森病的诊断相关。可避免的健康后果的风险增加。在没有接受常规神经科医生治疗的PD病例中，未充分使用必要的医疗护理和可避免结局的发生率最高。这些目标将通过使用现有的完整医疗保险医疗索赔数据对诊断为帕金森病的医疗保险受益人进行回顾性队列研究来实现。候选人将推导并验证PD特异性合并症指数（PDCI）。本研究计划的完成还将通过识别可预测PD结局和健康事件的合并症和健康服务事件来获得可操作的观察数据，为前瞻性以结局为中心的试验奠定基础，从而改善PD患者的管理和更好的结局。我是密苏里州圣路易斯市华盛顿大学医学院的神经病学和运动障碍专家助理教授。我的短期职业目标是获得在观察和结果研究中使用的先进流行病学和准实验技术的技能，并对合并症，护理差异和PD结果之间的关系进行初步调查。我的长期职业目标是利用在我的指导职业发展奖期间开发的技能来执行以患者为中心的结果和卫生服务研究，并作为独立资助的研究者进行PD结果的前瞻性观察研究。为了实现这些目标，我组建了一个多学科指导/咨询团队，其中包括成果研究、健康行为/卫生服务研究和流行病学方面的专家。我们一起设计了一个研究和职业发展计划，利用我目前在管理数据研究方面的技能，建立在我的初步数据基础上，这些数据表明PD护理和生存存在差异，并提供健康研究人口科学方面的技能发展。因此，我将成为一个独特的交叉训练的研究人员，在结果测量，健康差距，人口科学和空间分析的具体技能。我将获得领导多学科干预研究所需的培训和经验，以减少疾病负担和护理差异，改善PD的结果，并将这种专业知识协作应用于其他神经系统或神经退行性疾病。 公共卫生相关性：帕金森病（Parkinson Disease，PD）是一种常见的老年神经退行性疾病，以运动、认知、精神和自主神经为特征，目前尚无治愈方法。我们小组的初步数据表明，PD的治疗和结局存在差异。该提案的目标是确定其他医学疾病（共病）如何影响PD患者接受的医疗保健，以及他们所经历的健康结果。

DESCRIPTION (provided by applicant): Parkinson Disease (PD) is a common neurodegenerative disease of the elderly characterized by motor, cognitive, psychiatric and autonomic features, for which there is no cure. Our preliminary data suggest that there are racial and gender disparities in the utilization of neurologist care in PD, and that regular neurologist care is associated with lower hospitalization rates for PD related illnesses and improved survival. Explanations for these associations are lacking and serve as a critical barrier to progress in the field of Parkinson Disease management and survivorship. This project has three objectives. The first objective is for the candidate to use a multilevel study designed to examine how comorbid disease contributes to treatment disparities and clinical outcomes in PD. The second objective is to provide the candidate with a mechanism by which to obtain didactic training in population science, health services and health outcomes research. Finally, the third is for the candidate to receive intense mentoring in outcomes and observational research methods, which will allow her to continue work in the field of health disparities, outcomes and behavior research as an independently funded investigator. To achieve these objectives, the candidate plans to perform a patient level investigation of 130,000 beneficiaries with incident PD to examine the relative contribution of comorbid conditions on specialist utilization and patient outcomes. The specific aims will test the following hypotheses: 1) Comorbid illnesses have a measurable effect and varying prognostic impact on health outcomes (hospitalization and death) in PD, 2) Differences in the number and severity of comorbidities explain a proportion of the observed treatment disparities in Parkinson Disease, and 3) A diagnosis of Parkinson Disease will be associated with reduced adherence to recommended guidelines for management of common diseases and preventive care and will also be associated with an increased risk of avoidable health outcomes. Underuse of medically necessary care and the incidence of avoidable outcomes will be greatest among PD cases who do not receive regular neurologist care. These aims will be achieved by performing a retrospective cohort study of Medicare beneficiaries diagnosed with Parkinson Disease using existing complete Medicare medical claims data. The candidate will derive and validate a PD-specific comorbidity index (PDCI). The completion of this research plan will also result in actionable observational data by identifying comorbidities and health service events which predict outcomes and health events in PD, setting the stage for prospective outcome-centered trials that will lead to improved management of PD patients and better outcomes. I am an Assistant Professor of Neurology and Movement Disorders Specialist at Washington University School of Medicine in St. Louis, MO. My short-term career goals are to acquire skills in advanced epidemiological and quasi-experimental techniques used in observational and outcomes research and to perform initial investigations of the relationships between comorbidity, care disparities and outcomes in PD. My long term career goals are to use the skills developed during my mentored career development award period to perform patient-centered outcomes and health services research and to conduct prospective observational studies of PD outcomes as an independently funded investigator. To achieve these goals, I have assembled a multidisciplinary mentoring/advisory team with experts in outcomes research, health behavior/ health services research and epidemiology. Together, we have designed a research and career development plan that utilizes my current skills in administrative data research, builds on my preliminary data which suggest that there are disparities in PD care and survival, and provides skill development in population science of health research. As a result, I will emerge as a uniquely cross-trained researcher with specific skills in outcome measurement, health disparities, population science and spatial analysis. I will have acquired the training and experience necessary to lead multi-disciplinary investigations of interventions to reduce disease burden and disparities in care, to improve outcomes in PD and to provide collaborative application of this expertise to other neurological or neurodegenerative diseases. PUBLIC HEALTH RELEVANCE: Parkinson Disease (PD) is a common neurodegenerative disease of the elderly characterized by motor, cognitive, psychiatric and autonomic features, for which there is no cure. Preliminary data from our group suggests that there are disparities in treatment and outcomes in PD. The goal of this proposal is to identify how other medical illnesses (comorbid diseases) affects the health care people with PD receive, and the health outcomes they experience.