title: Association of specialist involvement and quality of care for Parkinson's disease.
abstract: Because Parkinson's disease (PD) has multiple neurological symptoms and often complex treatments, the quality of PD care may be higher when a specialist is involved. We examined the medical records, from 1998 to 2004, of 401 Los Angeles veterans with Parkinson's disease to determine whether care met key indicators of PD care quality. All care following a visit to a movement-disorder specialist or general neurologist was classified as specialty care. We compared adherence to each indicator by level of specialist involvement through logistic regression models. Over the study period, 10 indicators of PD care quality were triggered 2,227 times. Overall, movement disorder specialist involvement (78%) was associated with higher adherence to indicators than did general neurologist involvement (70%, P = 0.006) and nonneurologist involvement (52%, P < 0.001). The differences between movement disorder specialist and nonneurologist involvement were especially large for four indicators: treatment of wearing-off, assessments of falls, depression, and hallucinations. There is significant room for improving aspects of PD care quality among patients who do not have the involvement of a specialist. Quality of care interventions should involve specialists in management of motor symptoms and incorporate methods for routine assessment of nonmotor PD symptoms.
authors.affiliation: Parkinson's Disease Research, Education, and Clinical Center (PADRECC), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. Eric.Cheng@va.gov
authors.forename: Eric M
authors.initials: EM
authors.lastname: Cheng
authors.forename: Kari
authors.initials: K
authors.lastname: Swarztrauber
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Siderowf
authors.forename: Mahmood S
authors.initials: MS
authors.lastname: Eisa
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.forename: Stefanie
authors.initials: S
authors.lastname: Vassar
authors.forename: Erin
authors.initials: E
authors.lastname: Jacob
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
mesh_terms: D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D009069:Movement Disorders / Q000175:diagnosis / Q000628:therapy; D009462:Neurology / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000453:epidemiology* / Q000628:therapy*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data*; D013038:Specialization