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Cheng EM, Siderowf A, Swarztrauber K, Eisa M, Vickrey BG. Evidence-Based Guide to Key Care Processes in Parkinson's Disease Management. Los Angeles, CA: VA Greater Los Angeles Healthcare System; 2003 Sep 1.
The goal of this monograph is to serve as a resource guide to evidence-based, 'best practices' for clinicians who care for patients with Parkinson's Disease (PD). The monograph contains evidence summaries for 41 key care processes in PD. Each of these PD care processes was carefully reviewed and rated by a national panel of movement disorder experts - following a scientific process -and met threshold levels for validity. PD is a chronic, progressive neurological condition and a major cause of disability. Appropriate management of PD is challenging to clinicians because of the availability of a wide range of effective pharmaceutical and non-pharmaceutical interventions. To improve the medical care of PD patients throughout the Veteran's Administration (VA), the VA approved the establishment of six Parkinson's Disease Research, Education, and Clinical Centers (PADRECCs) in February, 2001. In 2002, a team of PADRECC health services researchers who are also VA neurologists developed and evaluated a set of evidence-based quality indicators for the management of PD. These researchers reviewed the medical literature for existing guidelines, randomized controlled trials, and observational studies relevant to the management of PD patients. After reviewing this literature, the team drafted a list of evidence-based care processes specific to the management of PD patients and prepared written summaries of the existing evidence for each care process. These processes are organized into 5 areas of care. Initial Diagnosis and Treatment of PDManagement of Motor ComplicationsManagement on Non-Motor ComplicationsManagement of Dementia, Depression, and PsychosisEducation and ReportingFollowing a specific protocol, in November, 2002, an expert panel of VA movement disorders specialists determined that 41 PD care processes met threshold levels for validity; in this monograph are the evidence summaries and supporting reference citations for these 41 PD-specific care processes. Of these 41 care processes, panel ratings for 16 met additional threshold criteria for (1) having the potential for a high impact on patient outcomes if the care process is followed, and (2) likely to reflect areas where there currently is 'room for improvement.' These 16 care processes are highlighted, indicating they may be areas to particularly 'target' for care improvement efforts. As research in PD care moves forward, the evidence supporting 'best practices' in PD care will evolve. A goal of the VA PADRECCs is to stay abreast of these changes and regularly update and disseminate this monograph as part of a broader effort to take new evidence in PD care 'from bench to bedside,' with the ultimate goal of improving the health of all veterans with PD.