of work This 3-year study has 3 specific aims: (1) Examine patterns of longitudinal use of eye care diagnostic and therapeutic services for major eye diseases;(2) Assess whether visual loss has been reduced by new innovations in ocular therapy for age-related macular degeneration (AMD) and greater intensity of therapy in diabetic eye diseases (both systemic and ocular);and (3) Assess utilization, conformance with guidelines, and cardiovascular, cerebrovascular, and nephropathy outcomes.
Aim 1 investigates hyperbolic discounting as an explanation of nonuse and diffusion of new therapies for treatment of AMD.
Aim 2 performs comparative effectiveness analysis of effects of AMD therapies and diabetic eye therapies on visual and other complications.
Aim 3 investigates effects of diagnostic and therapeutic procedures, including prescribed drugs, on cardiovascular, cerebrovascular, and nephropathy outcomes using instrumental variable (IV) and control function methods. To complement the IV analysis, this study investigates the process of selection into care, assessing roles of such observables as clinical, demographic and financial factors on selection. National, longitudinal data bases to be used include: Medicare 5% claims data merged with vital statistics information from 1991-2010;Health and Retirement Survey data on Medicare beneficiaries merged with Medicare claims for 1993-2008;and Medicare Current Beneficiary Survey data also merged with administrative information from Medicare, 1991-2009.

Public Health Relevance

This study provides important information about reasons individuals use Medicare-covered services. New and promising treatments in age-related macular degeneration have been developed but their effects on long-run visual outcomes and associated complications in a national setting remain to be demonstrated. Our study will provide recent national evidence on these issues. We will document whether appropriate use of recommended care and therapeutic procedures leads to better health outcomes among persons with (1) major eye diseases and (2) diagnosed with diabetes mellitus.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Baker, Colin S
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Duke University
Schools of Arts and Sciences
United States
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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
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, 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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