Determining the impact of specialized care on health outcomes and health care utilization in Parkinsonism

Abstract

BackgroundAlthough care of Parkinsonism (PKM) is assumed to be optimally provided by movement disorder neurologists within an interdisciplinary clinic model, there is a paucity of published data to support this. ObjectivesTo investigate the impact of movement disorder neurologist care of individuals with Parkinsonism (PKM). MethodsA retrospective exposure design was adopted using administrative data. Incident PKM individuals were identified in billing claims. A nine-year exposure period to movement disorder neurologist, general neurologist and non-neurologist care was calculated based on the billing codes. Regression models were used to test the association of provider exposure on time to death and long-term care (LTC) admission. Linear models were used to test varying provider exposure and hospital admissions, hospital days and emergency department visits. Results1914 incident individuals were identified. There was no difference in PKM mortality, emergency visits, hospital admissions, or hospital days between providers, however exposure to general neurology and non-neurology care was associated with a significantly higher risk of admission to LTC compared to movement disorder neurologist care (HR 1.43; 95% CI 1.09–1.87 for general neurology (p-value = 0.0089); HR 1.61; 95% CI 1.25–2.05 for non-neurology (p-value = 0.0002), respectively. ConclusionMovement disorder neurologist care is associated with a lower risk of admission to LTC over general neurologist care in individuals with PKM.