The Institute of Medicine has defined patient-centered care (PCC) as, Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.[1] This definition is based on the two fundamental characteristics of PCC, patient involvement in and the individualization of patient care.[2] The overarching goal of my research is to move ophthalmic care closer to a shared-decision making model. This grant has been created to reflect the initiation of this process by focusing on establishing PCC for diabetic macular edema (DME). Diabetic retinopathy is the leading cause of blindness among working age adults in the US, with most of the visual impairment resulting from DME.[3, 4] Recently, anti-vascular endothelial growth factor (anti-VEGF) agents have become the gold-standard for treating fovea-involving DME.[5-11] The visual gains of this treatment, however, come at a cost of increased office visits and intravitreal injections, which can greatly impact a patient's adherence with their treatment. To better address underlying factors affecting patient adherence, this grant's first aim will focus the influence of patient demographic and insurance characteristics have on initial choice of treatment for diabetic macular edema. To accomplish this a large, national administrative medical claims database will analyze how baseline patient characteristics (i.e. age, gender, race, insurance type and out-of-pocket visit costs) can influence the initial treatment choice received by incident DME patients.
The second Aim will study the influence of choice of initial anti-VEGF therapy on the frequency of visits and injections. Again using the previously mentioned database, cohorts will be created based on patients who initially received ranibizumab or bevacizumab as first line treatment and followed for two years assessing differences in visit and treatment frequencies over that time. The last aim will formally assess patient preferences for the frequency of office visits and intravitreal injections they receive in relation to the potential visual change that could be expected. This wil be done through extensive surveying of DME patients and systematically assessing their preferred outcomes by making them make discrete choices between more frequent care and better vision. Completion of these aims will inform patients, ophthalmologists and health policy experts about the influences on and outcomes of care provided to DME patients that will allow for a more personalized and patient-centered approach to the treatment offered.
The objective of this grant will be to perform studies that will allow for a patient-centered care approach to patients with diabetic macular edema (DME). These studies will help in the understanding of how the choices being made prior to and during their treatment influence care for DME and will help to promote a true shared-decision making model between patients and doctors.
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