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*209. Relative Utilization and Health-Related Quality of Life of Patients with Parkinsonís Disease

H Gage, Center for Health Quality, Outcomes & Economic; A Hendricks, Center for Health Quality, Outcomes & Economic; S Zhang, Center for Health Quality, Outcomes & Economic; L Kazis, Center for Health Quality, Outcomes & Economic

Objectives: To compare the characteristics, resource use and health-related quality of life (HRQoL) of veterans with a diagnosis of Parkinsonís disease (PD) with VA enrollees as a whole and with other chronic conditions. VHA treated 55,637 people with PD over the fiscal years (FYs) 1997-1999. Understanding the relative health status and utilization of this patient group is important for the development of plans for managing PD care in VA.

Methods: The 1999 Health Survey of Veteran Enrollees included 14,530 respondents with a diagnosis of PD (ICD-9: 332.0, 333.1, 333.0) recorded in VA utilization files at any time during FY 1997-1999. We compared this group with the survey sample of VA enrollees as a whole (n= 981,903) with respect to: socio-economic and demographic features, physical and mental health and wellbeing, health insurance coverage, and VA utilization. We also explored the age-standardized distribution of PD patients across VA networks. We used descriptive statistics and chi-square tests to compare groups.

Results: Parkinsonís disease is a condition of the elderly and we found that VA patients with PD were more likely to be over 65 years of age than other patients (76.5% vs 44.5%). Consequently, they were more likely to have 12 years or less of formal education (64.2% vs 53.8%) and to report deterioration in physical health (57.4% vs 39.6%) and mental health (38.0% vs 27.1%) over the preceding 12 months. More of them used VA in that period (48.1% vs 43.1%). Compared to VA patients as a whole, a lower proportion of PD patients had private insurance coverage (20.7% vs 40.0%) and they were more likely to make exclusive use of the VA for inpatient (53.5% vs 48.2%) and outpatient (54.1% vs 46.6%) care and to plan to make the VA their primary source of care in the future (78.5% vs 66.4%). On SF-36 component summary measures, PD patients reported physical and mental health status (29.98 and 39.28) similar to chronic heart failure (28.14 and 39.74) and stroke (29.48 and 40.54) patients but worse than VA enrollees with arthritis (32.33 and 43.22) and diabetes (32.53 and 43.07). Given the sample size, all the above differences are significant at least at the p .01 level. Stratified for age, the distributions of Parkinsonís patients across VISNs reveal a disproportionate number in VISNs 11-16, 18-19.

Conclusions: About 1.5% of veteran enrollees have a diagnosis of PD. As a group they record deteriorating health status, high reliance on VA and relatively high utilization compared with many other chronic patient populations. Their HRQoL is as low as patients with chronic heart failure and stroke.

Impact: PD has received relatively little attention from health services research. This descriptive study documents the relative condition of PD patients in VA and identifies them as high service users. It underscores the importance of improving the HRQoL of these patients and the potential resource-saving implications of such initiatives.