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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1012 — Effects of Specialized Centers on Processes of Chronic Care Delivery for Patients with Parkinson's Disease

Charns MP (COLMR Boston CoE), Cramer IE (COLMR Boston CoE), Meterko MM (COLMR Boston CoE), Stolzman K (COLMR Boston CoE), Pogoda TK (COLMR Boston CoE), Holloway RG (University of Rochester), Lin H (COLMR Boston CoE), Hendricks A (VA Boston Health Care System)

Objectives:
To determine whether patients with Parkinson's disease (PD) receive care more consistent with the Chronic Care Model (CCM) at VAMCs having specialized Parkinson's Disease Research, Education and Clinical Centers (PADRECCs) than at other VAMCs.

Methods:
Using FY2005 VA administrative data, patients with a diagnosis of PD (ICD-9-CM code 332) were randomly sampled from three strata: those seen at any one of the six PADRECCs, those seen in any of 12 matched comparison VAMCs, and those seen in any other VAMC. Patient surveys assessing general and PD condition-specific health status (SF12, co-morbidities, change in physical and mental health conditions, PDQ8, UPDRS-ADL, and hallucinations), adherence to the CCM (Patient Assessment of Chronic Illness Care - PACIC), and demographics were mailed to 2,796 patients who passed an initial screen and provided informed consent. Responses were analyzed using hierarchical linear modeling, with patients clustered by VAMC. Both individual- and VAMC-level covariates, including whether the VAMC was the site of a PADRECC, were included.

Results:
We received 2,330 completed patient surveys (83% response rate). Statistically significant relationships were found between PACIC measures of conformity to the CCM and all of the health status measures except experiencing hallucinations, as well as between PACIC scales and several demographics including age, Hispanic descent, education, employment, and marital status. The only facility characteristic significantly related to the PACIC measures was whether the VAMC was the site of a PADRECC; sites with a PADRECC had significantly higher scores on all five CCM scales (p < 0.05).

Implications:
Controlling for patient demographics and health status, patients seen at a VAMC with a PADRECC perceived their care as being more consistent with the CCM than did patients seen in other VAMCs. This indicates that care for patients with PD provided at PADRECCs is associated with more informed and activated patients and a more prepared practice team.

Impacts:
VA has invested in specialized centers for PD and for other conditions, yet little was known about these centers' effects on delivery of care. This study informs VA decision making and the literature on health care organizations regarding organization into specialty centers.


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