From the Department of Pharmaceutical Health Services Research (A.B.G., E.O., H.A., A.J.) and Department of Pharmacy Practice and Science (L.H.), University of Maryland School of Pharmacy, Baltimore; Pfizer Inc (D.E.M.), Collegeville, PA; Pfizer Inc (D.G.), Cambridge, MA; Pfizer Inc (J.A.), New York, NY; and Department of Neurology (L.M.S.), University of Maryland, School of Medicine, Baltimore.
Neurology. 2021 Aug 10;97(6):e597-e607. doi: 10.1212/WNL.0000000000012290. Epub 2021 May 27.
To compare differences in health care resource utilization (HcRU) over time between Medicare beneficiaries with and without Parkinson disease (PD).
This retrospective observational study used the Chronic Conditions Data Warehouse (5% Medicare sample) between 2005 and 2015. In a propensity score-matched (age, sex, race, and comorbidity adjusted) sample of beneficiaries with and without PD, we examined all-cause HcRU due to inpatient admissions, emergency department (ED) admissions, skilled nursing facility (SNF) admissions, health care provider encounters, neurologist visits, rehabilitation service visits, and non-PD medication fills. Relative to beneficiaries without PD, we reported adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for beneficiaries with PD using generalized linear models with log link and negative binomial variance functions.
A total of 467,064 Medicare enrollees (unmatched sample) met the inclusion criteria. Of these, 3.3% had PD. In the matched sample and relative to beneficiaries without PD, beneficiaries with PD displayed higher rates of inpatient admissions (IRR 1.29, 95% CI 1.24-1.34), ED admissions (IRR 1.31, 95% CI 1.27-1.34), SNF admissions (IRR 2.00, 95% CI 1.92-2.09), health care provider encounters (IRR 1.18, 95% CI 1.16-1.20), neurologist visits (IRR 5.57, 95% CI 5.35-5.78), rehabilitation service visits (IRR 1.47, 95% CI 1.41-1.53), and non-PD medication fills (IRR 1.10, 95% CI 1.08-1.11) over time.
These results reflect patterns of medical care among Medicare beneficiaries with PD. The findings can help clinicians, payers, and policy makers make evidence-based decisions for the allocation of scarce health care resources for PD management.
This study provides Class II evidence that Medicare beneficiaries with PD use more health care resources than matched controls without PD.
比较有和没有帕金森病（PD）的 Medicare 受益人群在医疗保健资源利用（HcRU）方面随时间的差异。
本回顾性观察性研究使用了 2005 年至 2015 年期间的慢性疾病数据仓库（5%的 Medicare 样本）。在一个有和没有 PD 的受益人的倾向评分匹配（年龄、性别、种族和合并症调整）样本中，我们检查了所有原因导致的 HcRU，包括住院入院、急诊部（ED）入院、熟练护理机构（SNF）入院、医疗保健提供者就诊、神经科就诊、康复服务就诊和非 PD 药物治疗。使用具有对数链接和负二项式方差函数的广义线性模型，我们报告了相对于没有 PD 的受益人的调整发病率比值（IRR）和 95%置信区间（CI）。
共有 467064 名 Medicare 参保人（未匹配样本）符合纳入标准。其中，3.3%患有 PD。在匹配样本中，与没有 PD 的受益人群相比，PD 患者的住院入院率（IRR 1.29，95%CI 1.24-1.34）、ED 入院率（IRR 1.31，95%CI 1.27-1.34）、SNF 入院率（IRR 2.00，95%CI 1.92-2.09）、医疗保健提供者就诊率（IRR 1.18，95%CI 1.16-1.20）、神经科就诊率（IRR 5.57，95%CI 5.35-5.78）、康复服务就诊率（IRR 1.47，95%CI 1.41-1.53）和非 PD 药物治疗率（IRR 1.10，95%CI 1.08-1.11）均随时间增加。
这些结果反映了 Medicare 有 PD 患者的医疗保健模式。这些发现可以帮助临床医生、支付者和政策制定者为 PD 管理的稀缺医疗保健资源分配做出基于证据的决策。
本研究提供了 II 级证据，表明有 PD 的 Medicare 受益人群比没有 PD 的匹配对照人群使用更多的医疗保健资源。
