This four-year study has four major objectives. (1) For elderly persons with diabetes mellitus diabetic retinopathy, glaucoma, and macular degeneration -- diseases that can cause serious impairments to vision and blindness -- we will analyze determinants of utilization of eye care services, and whether or not Medicare beneficiaries with diabetes/diabetic retinopathy and glaucoma receive care in accordance with minimal process of eye care standards. Such standards have been disseminated as guidelines by professional organizations. In this phase, we will address these issues. How do data on patient self-report of diagnosis compare with those obtained from physicians' diagnoses? What proportions of persons with the study diseases receive care at least at the minimum level of guidelines? Holding many factors constant, are there racial differences in treatments for these diseases? (2) We will study the longitudinal course of these diseases, measured in terms of visual and general functional status -- physical, cognitive -- and in terms of placement in a nursing home, and survival. We will analyze effects of care on changes in vision and the other outcome measures. Our data are unique both in terms of the length of time over which patients are followed and in the range of health outcome monitored. (3) We will assess the impact of diabetes, glaucoma, and macular degeneration on total Medicare and Medicaid program cost and on costs privately incurred. Program cost will include cost of vision and non-vision services. In our framework, program cost and patient adherence to guidelines will be jointly determined. (4) We will replicate the analysis of the first 2 objectives for complications of diabetes other than for eyes. We will also specify and estimate a dynamic model of utilization of Medicare-covered services by persons with diabetes -- both vision and nonvision care. The main database will be the National Long-Term Care Survey (NLTCS) for 1982-2001, merged with Medicare claims data for 1982-2001. Eleven papers are planned.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG017473-04
Application #
6724860
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Phillips, John
Project Start
2001-04-15
Project End
2005-08-31
Budget Start
2004-04-01
Budget End
2005-08-31
Support Year
4
Fiscal Year
2004
Total Cost
$191,730
Indirect Cost
Name
Duke University
Department
Administration
Type
Schools of Arts and Sciences
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Yashkin, Arseniy P; Kravchenko, Julia; Yashin, Anatoliy I et al. (2018) Mortality and Macrovascular Risk in Elderly With Hypertension and Diabetes: Effect of Intensive Drug Therapy. Am J Hypertens 31:220-227
Akushevich, Igor; Yashkin, Arseniy P; Kravchenko, Julia et al. (2018) Identifying the causes of the changes in the prevalence patterns of diabetes in older U.S. adults: A new trend partitioning approach. J Diabetes Complications 32:362-367
Akushevich, I; Yashkin, A P; Kravchenko, J et al. (2017) Theory of partitioning of disease prevalence and mortality in observational data. Theor Popul Biol 114:117-127
Mroz, Thomas A; Picone, Gabriel; Sloan, Frank et al. (2016) Screening for a Chronic Disease: A Multiple Stage Duration Model with Partial Observability. Int Econ Rev (Philadelphia) 57:915-934
Chen, Yiqun; Hahn, Paul; Sloan, Frank A (2016) Changes in Visual Function in the Elderly Population in the United States: 1995-2010. Ophthalmic Epidemiol 23:137-44
Hahn, Paul; Yashkin, Arseniy P; Sloan, Frank A (2016) Effect of Prior Anti-VEGF Injections on the Risk of Retained Lens Fragments and Endophthalmitis after Cataract Surgery in the Elderly. Ophthalmology 123:309-15
Yashkin, Arseniy P; Hahn, Paul; Sloan, Frank A (2016) Introducing Anti-Vascular Endothelial Growth Factor Therapies for AMD Did Not Raise Risk of Myocardial Infarction, Stroke, and Death. Ophthalmology 123:2225-31
Chen, Yiqun; Sloan, Frank A; Yashkin, Arseniy P (2015) Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death. J Diabetes Complications 29:1228-33
Abel, Anne S; Yashkin, Arseniy P; Sloan, Frank A et al. (2015) Effect of diabetes mellitus on giant cell arteritis. J Neuroophthalmol 35:134-8
Yashkin, Arseniy P; Picone, Gabriel; Sloan, Frank (2015) Causes of the change in the rates of mortality and severe complications of diabetes mellitus: 1992-2012. Med Care 53:268-75

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