McKee Kathleen E, Rafferty Miriam R, Sakata Theadora W, Hedges David M, Griffith Garett J, Bingham Maddison M K, Obradovich Stephanie A, Francis M Nicholas, Corcos Daniel M
Department of Neurology, Intermountain Medical Center Neurosciences Institute, Intermountain Health, Salt Lake City, UT, United States.
Shirley Ryan AbilityLab, Chicago, IL, United States.
Front Sports Act Living. 2025 Jun 2;7:1529075. doi: 10.3389/fspor.2025.1529075. eCollection 2025.
As Parkinson's disease (PD) progresses, relatively mild symptoms advance to a major disorder that affects every organ system in the body. Current care for people with PD (PwP) reacts to rising disability. There is a missed opportunity to keep PwP as healthy as possible. In this perspective, we spell out our vision for a proactive, value-based health care model built around a patient-centered integrated practice unit (IPU) for PD. The IPU will provide integrated interdisciplinary care overseen by a specialized Parkinson's primary care physician working closely with a movement disorders neurologist. The IPU will implement an evidence-based exercise program for people early in the disease. The focus of this intervention is a heart rate driven high-intensity aerobic exercise program, which is the only treatment with evidence that it can slow disease progression. It will also include resistance exercises, flexibility exercise and balance exercise. For people whose disease is moderate or severe, the IPU will provide care curated through a network of rehabilitation providers with expertise in PD all of whom understand the exercise prescription. By integrating care, slowing disease progression, and incorporating specialized rehabilitation we anticipate improving healthspan. In creating the IPU as a fully capitated (shared-risk) model in which the IPU and the insurance company assume joint accountability for quality and cost of care we anticipate demonstrating financial sustainability of implementing the exercise prescription and providing integrated care.
随着帕金森病（PD）的进展，相对轻微的症状会发展为一种影响身体各个器官系统的重大疾病。目前对帕金森病患者（PwP）的护理是对日益增加的残疾状况做出反应。我们错失了让帕金森病患者尽可能保持健康的机会。从这个角度来看，我们阐述了我们对于一种积极主动、基于价值的医疗保健模式的愿景，该模式围绕一个以患者为中心的帕金森病综合诊疗单元（IPU）构建。该IPU将提供综合的跨学科护理，由一名专门的帕金森病初级保健医生监督，该医生与一名运动障碍神经科医生密切合作。IPU将为疾病早期的患者实施一项基于证据的运动计划。这项干预措施的重点是一项由心率驱动的高强度有氧运动计划，这是唯一有证据表明可以减缓疾病进展的治疗方法。它还将包括抗阻运动、柔韧性运动和平衡运动。对于病情中度或重度的患者，IPU将通过一个由在帕金森病方面具有专业知识的康复服务提供者组成的网络提供精心策划的护理，所有这些提供者都了解运动处方。通过整合护理、减缓疾病进展以及纳入专门的康复治疗，我们预计可以改善健康寿命。在创建IPU作为一个完全按人头付费（共担风险）的模式时，IPU和保险公司将共同对护理质量和成本负责，我们预计将证明实施运动处方和提供综合护理在财务上的可持续性。
