2011 National Meeting

3110 — Evaluating the Impact of Parkinson’s Disease Research, Education, and Clinical Centers (PADRECCs): Preliminary Findings

Williams S (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)) , Stolzmann K (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Meterko M (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Hendricks A (VA Boston Healthcare System), Nealon-Seibert M (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Pogoda T (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Holloway R (University of Rochester School of Medicine & Dentistry), Ballah K (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Charns M (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR)), Cramer I (VA Boston Healthcare System, Center for Organization Leadership Mangement Research (COLMR))

Objectives:
In 2001, the Department of Veterans Affairs (VA) established six Parkinson’s Disease Research, Education, and Clinical Centers (PADRECCs) to provide multidisciplinary specialized care, conduct research, and disseminate knowledge to improve care for Veterans with Parkinson’s disease (PD). The current study compared Veterans treated for PD at VA medical centers (VAMCs) with and without PADRECCs on demographics, general health status, functioning, and care satisfaction at two time points.

Methods:
Screener letters were mailed to stratified random samples of PD patients identified through VA administrative data. Those confirming PD diagnosis in 2006 (n = 2,796) and 2010 (n = 2,418) were mailed a questionnaire assessing demographics, general health status, PD-symptom severity/functioning, and satisfaction with care. Chi-square analyses and t-tests were used to compare Veterans receiving care at VAMCs with and without a PADRECC.

Results:
The survey completion rates in 2006 (83.3%; n = 2,330) and in 2010 (77.3%; n = 1,870) were satisfactory. In both years, Veterans treated in PADRECC VAMCs reported better (p < .01) general health status (SF-12 overall health item) and fewer physical co-morbidities (p < .01) than their counterparts. No significant differences emerged between the two groups in either year regarding severity of PD-specific symptoms (assessed by the UPDRS and PDQ-8). In both years, patients treated at PADRECC VAMCs reported higher scores on all dimensions of the PACIC, an instrument which assesses provider adherence to the Wagner model of chronic illness care (p < 0.001). PADRECC VAMC patients also reported significantly higher scores on several SHEP measures including satisfaction with care (p < 0.001) and quality of care (p < 0.001). Veterans at PADRECC VAMCs were significantly less likely to be married (p < 0.05) in both years; no other consistent demographic differences were observed.

Implications:
Veterans treated in PADRECC VAMCs reported better general health than Veterans in non-PADRECC VAMCs, but the two groups did not differ with regard to PD-specific symptoms. In preliminary analyses without adjusting for general health status, Veterans treated in PADRECC VAMCs report care more consistent with the chronic care model and greater overall satisfaction.

Impacts:
Care delivery structures organized around a chronic disease such as PD may provide disease management that is more consistent with the chronic care model.