Michelle E Fullard1, Dylan P Thibault2, Andrew Hill2, Joellyn Fox2, Danish E Bhatti2, Michelle A Burack2, Nabila Dahodwala2, Elizabeth Haberfeld2, Drew S Kern2, Olga S Klepitskava2, Enrique Urrea-Mendoza2, Phillip Myers2, Jay Nutt2, Miriam R Rafferty2, Jason M Schwalb2, Lisa M Shulman2, Allison W Willis2. 1. From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore. Michelle.Fullard@uphs.upenn.edu. 2. From the Departments of Neurology (M.E.F., D.P.T., A.H., N.D., A.W.W.) and Biostatistics and Epidemiology (D.P.T., A.H., A.W.W.), University of Pennsylvania School of Medicine; Dan Aaron Parkinson's Rehabilitation Center (J.F.), Leonard Davis Institute of Health Economics (A.W.W.), and Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania, Philadelphia; Department of Neurobiological Sciences (D.E.B.), University of Nebraska Medical Center, Omaha; Department of Neurology (M.A.B.), University of Rochester, NY; Department of Neurology (E.H.), Temple University, Philadelphia, PA; Department of Neurology (D.S.K., O.S.K.), University of Colorado, Aurora; Greenville Health System (E.-U.M.), SC; Parkinson's Disease Foundation Advocate Group (P.M.), Lakeport, CA; Department of Neurology (J.N.), Oregon Health Sciences University, Portland; Center for Education in Health Sciences (M.R.R.), Northwestern University, Evanston, IL; Department of Neurosurgery (J.M.S.), Henry Ford Medical Group, Detroit, MI; Department of Neurology (L.M.S.), University of Maryland School of Medicine, Baltimore.
Abstract
OBJECTIVE: To examine rehabilitation therapy utilization for Parkinson disease (PD). METHODS: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). RESULTS: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. CONCLUSIONS: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.
OBJECTIVE: To examine rehabilitation therapy utilization for Parkinson disease (PD). METHODS: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). RESULTS: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. CONCLUSIONS: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.
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