Parkinson Disease Disparities and Outcomes

描述(申请人提供)：帕金森病(PD)是一种常见的老年人神经退行性疾病，以运动、认知、精神和自主功能为特征，目前尚无治疗方法。我们的初步数据表明，在帕金森病中神经科医生的使用存在种族和性别差异，定期的神经科医生护理与较低的帕金森病相关疾病的住院率和提高存活率相关。缺乏对这些关联的解释，并成为帕金森病管理和生存领域取得进展的关键障碍。这个项目有三个目标。第一个目标是候选人使用一项多水平研究，旨在检查并存疾病如何影响帕金森病的治疗差异和临床结果。第二个目标是为候选人提供一种机制，通过这种机制获得人口科学、卫生服务和健康结果研究方面的教学培训。最后，第三个是 对于候选人来说，她将接受结果和观察性研究方法方面的密集指导，这将使她能够作为一名独立资助的研究员继续在健康差距、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名帕金森病患者进行患者层面的调查，以检查合并疾病对专科医生利用率和患者结果的相对贡献。这些具体目标将检验以下假设：1)并存疾病对帕金森病的健康结果(住院和死亡)有可测量的影响和不同的预后影响，2)并存疾病的数量和严重程度的差异解释了帕金森病观察到的治疗差异的一部分，以及3)帕金森病的诊断将与对常见疾病管理和预防护理推荐指南的遵守减少相关，也将与可避免的健康结果的风险增加相关。在没有接受常规神经科医生护理的帕金森病患者中，医疗必要护理的使用不足和可避免结果的发生率最高。这些目标将通过使用现有的完整的联邦医疗保险医疗索赔数据对被诊断为帕金森病的联邦医疗保险受益人进行回顾性队列研究来实现。候选人将得出并验证帕金森病特定的共病指数(PDCI)。这项研究计划的完成还将通过确定预测帕金森病患者结局和健康事件的合并症和健康服务事件，产生可操作的观察数据，为以结果为中心的前瞻性试验奠定基础，这些试验将导致对帕金森病患者的改善管理和更好的结果。我是密苏里州圣路易斯市华盛顿大学医学院神经病学和运动障碍专家的助理教授。我的短期职业目标是获得高级流行病学和准实验技术方面的技能，用于观察性和结果研究，并对帕金森病的合并症、护理差异和结果之间的关系进行初步调查。我的长期职业目标是使用在我的指导职业发展奖励期间培养的技能来执行以患者为中心的结果和医疗服务研究，并作为一名独立资助的调查员对PD结果进行前瞻性观察研究。为了实现这些目标，我组建了一个多学科指导/咨询团队，成员包括结果研究、健康行为/健康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，这些数据表明在PD护理和生存方面存在差异，并提供人口健康研究方面的技能发展。因此，我将成为一名独特的交叉培训的研究人员，在结果衡量、健康差距、人口科学和空间分析方面拥有特定技能。我将获得必要的培训和经验，以领导对干预措施的多学科调查，以减少疾病负担和护理差距，改善帕金森病的结果，并将这种专业知识合作应用于其他神经或神经退行性疾病。

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.