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Neurologist care in Parkinson disease: a utilization, outcomes, and survival study.
Neurology. 2011 Aug 30; 77(9):851-7.Neur

Abstract

OBJECTIVE

To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes.

METHODS

This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty.

RESULTS

More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79).

CONCLUSIONS

Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.

Authors+Show Affiliations

Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA willisa@neuro.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21832214

Citation

Willis, A W., et al. "Neurologist Care in Parkinson Disease: a Utilization, Outcomes, and Survival Study." Neurology, vol. 77, no. 9, 2011, pp. 851-7.
Willis AW, Schootman M, Evanoff BA, et al. Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology. 2011;77(9):851-7.
Willis, A. W., Schootman, M., Evanoff, B. A., Perlmutter, J. S., & Racette, B. A. (2011). Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology, 77(9), 851-7. https://doi.org/10.1212/WNL.0b013e31822c9123
Willis AW, et al. Neurologist Care in Parkinson Disease: a Utilization, Outcomes, and Survival Study. Neurology. 2011 Aug 30;77(9):851-7. PubMed PMID: 21832214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. AU - Willis,A W, AU - Schootman,M, AU - Evanoff,B A, AU - Perlmutter,J S, AU - Racette,B A, Y1 - 2011/08/10/ PY - 2011/8/12/entrez PY - 2011/8/13/pubmed PY - 2011/10/28/medline SP - 851 EP - 7 JF - Neurology JO - Neurology VL - 77 IS - 9 N2 - OBJECTIVE: To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes. METHODS: This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty. RESULTS: More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79). CONCLUSIONS: Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/21832214/Neurologist_care_in_Parkinson_disease:_a_utilization_outcomes_and_survival_study_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=21832214 DB - PRIME DP - Unbound Medicine ER -