The quality of care delivered to Parkinson's disease patients in the U.S. Pacific Northwest Veterans Health System.
BACKGROUND
Parkinson's disease (PD) is the second most common chronic neurological disorder of the elderly. Despite the fact that a comprehensive review of general health care in the United States showed that the quality of care delivered to patients usually falls below professional standards, there is limited data on the quality of care for patients with PD.


METHODS
Using the administrative database, the Pacific Northwest Veterans Health Administration (VHA) Data Warehouse, a population of PD patients with encounters from 10/1/98-12/31/04 were identified. A random sample of 350 patient charts underwent further review for diagnostic evaluation. All patients whose records revealed a physician diagnosis of definite or possible Idiopathic Parkinson's (IPD) disease (n = 150) were included in a medical chart review to evaluate adherence to five evidence-based quality of care indicators.


RESULTS
For those care indicators with good inter-rater reliability, 16.6% of care received by PD patients was adherent for annual depression screening, 23.4% of care was adherent for annual fall screening and, 67.3% of care was adherent for management of urinary incontinence. Patients receiving specialty care were more likely to be adherent with fall screening than those not receiving specialty care OR = 2.3, 95%CI = 1.2-4.2, but less likely to be adherent with management of urinary incontinence, OR = 0.3, 95%CI = 0.1-0.8. Patients receiving care outside the VA system were more likely to be adherent with depression screening OR = 2.4, 95%CI = >1.0-5.5 and fall screening OR = 2.2, 95%CI = 1.1-4.4.


CONCLUSIONS
We found very low rates of adherence for annual screening for depression and falls for PD patients but reasonable adherence rates for management of urinary incontinence. Interestingly, receiving concurrent specialty care did not necessarily result in higher adherence for all care indicators suggesting some coordination and role responsibility confusion. The increased adherence in PD patients receiving care outside the VA system suggests that patients with outside care may demand better care within the VA system.
Swarztrauber
Kari
K
Providence Health System, Newberg, Oregon, USA. swarztra@stanfordalumni.org
Graf
Eric
E
Cheng
Eric
E
D000058:Accidental Falls / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000592:standards*; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000592:standards / Q000639:trends; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008485:Medical Audit; D008511:Medicine / Q000592:standards; D015205:Northwestern United States; D015588:Observer Variation; D010300:Parkinson Disease / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care; D013038:Specialization; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000628:therapy