Lee Paul P, Feldman Zachary W, Ostermann Jan, Brown Derek S, Sloan Frank A
Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27708, USA.
Ophthalmology. 2003 Oct;110(10):1952-9. doi: 10.1016/S0161-6420(03)00817-0.
To assess the rate of annual eye examinations over time among older Americans with diabetes and chronic eye diseases.
Longitudinal analysis of Medicare claims data.
Random sample of Medicare beneficiaries aged 65 years or older.
Beneficiaries were followed between 1991 and 1999, unless mortality or enrollment in a health maintenance organization for > 6 months in a given 12-month period intervened. All claims data (both physician and facility) during this time were analyzed for the presence of International Classification of Diseases 9 codes consistent with 1 of the 3 study conditions and the performance of eye examinations.
Claims submitted by optometrists, ophthalmologists, or other providers of eye care for subjects with diabetes, glaucoma, or age-related macular degeneration (ARMD). Rates were calculated on the basis of a 15-month time window for annual examinations rather than for 12 months to allow for less than full compliance with the guidelines for various reasons (e.g., bad weather).
Among those with diabetes in this population, 50% to 60% had annual eye examinations in a 15-month period. Of those followed for at least 75 months after diagnosis, about three quarters had one or more 15-month gaps between visits. For subjects diagnosed with glaucoma, most visit rates were in the 70% to 90% range per 15-month period. The percentage of subjects with at least one 15-month period with no visits was considerably lower than for diabetes. The patterns for those with ARMD were in between those for diabetes and glaucoma. Over a nine-year period, only slightly over half of persons with at least one of the study conditions complied with practice guidelines.
Annual eye examinations for persons diagnosed with diabetes, glaucoma, and ARMD are important for detecting potentially treatable vision loss among those already diagnosed with these conditions. Currently, actual rates of eye examinations for persons diagnosed with the study conditions fall far short of recommended rates. As such, approaches to enhancing longitudinal follow-up of those already in the eye care system are needed.
评估患有糖尿病和慢性眼病的美国老年人随时间推移进行年度眼部检查的比例。
对医疗保险理赔数据进行纵向分析。
65岁及以上医疗保险受益人的随机样本。
对受益人在1991年至1999年期间进行随访，除非在给定的12个月期间内死亡或加入健康维护组织超过6个月。分析这段时间内所有的理赔数据（包括医生和医疗机构的），以确定是否存在与三种研究疾病之一相符的国际疾病分类第9版编码以及眼部检查的执行情况。
验光师、眼科医生或其他眼部护理提供者为患有糖尿病、青光眼或年龄相关性黄斑变性（ARMD）的受试者提交的理赔申请。基于15个月的时间窗口计算年度检查率，而非12个月，以考虑到由于各种原因（如恶劣天气）未完全遵循指南的情况。
在该人群中患有糖尿病的患者中，50%至60%在15个月期间进行了年度眼部检查。在诊断后至少随访75个月的患者中，约四分之三的患者在就诊之间有一个或多个15个月的间隔。对于被诊断为青光眼的受试者，大多数就诊率在每15个月70%至90%的范围内。至少有一个15个月未就诊的受试者百分比远低于糖尿病患者。患有ARMD的患者的模式介于糖尿病和青光眼患者之间。在九年期间，至少患有一种研究疾病的患者中只有略超过一半的人遵循了实践指南。
对被诊断患有糖尿病、青光眼和ARMD的人进行年度眼部检查对于检测已被诊断患有这些疾病的人群中潜在可治疗的视力丧失很重要。目前，被诊断患有研究疾病的人的实际眼部检查率远低于推荐率。因此，需要采取措施加强对已进入眼部护理系统的人群的纵向随访。
