title: Neurologist care in Parkinson disease: a utilization, outcomes, and survival study.
abstract: OBJECTIVE
  To investigate the utilization of neurologist providers in the treatment of patients with Parkinson disease (PD) in the United States and determine whether neurologist treatment is associated with improved clinical outcomes.
  
  
  METHODS
  This was a retrospective observational cohort study of Medicare beneficiaries with PD in the year 2002. Multilevel logistic regression was used to determine which patient characteristics predicted neurologist care between 2002 and 2005 and compare the age, race, sex, and comorbidity-adjusted annual risk of skilled nursing facility placement and hip fracture between neurologist- and primary care physician-treated patients with PD. Cox proportional hazards models were used to determine the adjusted 6-year risk of death using incident PD cases, stratified by physician specialty.
  
  
  RESULTS
  More than 138,000 incident PD cases were identified. Only 58% of patients with PD received neurologist care between 2002 and 2005. Race and sex were significant demographic predictors of neurologist treatment: women (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.76-0.80) and nonwhites (OR 0.83, 95% CI 0.79-0.87) were less likely to be treated by a neurologist. Neurologist-treated patients were less likely to be placed in a skilled nursing facility (OR 0.79, 95% CI 0.77-0.82) and had a lower risk of hip fracture (OR 0.86, 95% CI 0.80-0.92) in logistic regression models that included demographic, clinical, and socioeconomic covariates. Neurologist-treated patients also had a lower adjusted likelihood of death (hazard ratio 0.78, 95% CI 0.77-0.79).
  
  
  CONCLUSIONS
  Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA willisa@neuro.wustl.edu
authors.forename: A W
authors.initials: AW
authors.lastname: Willis
authors.forename: M
authors.initials: M
authors.lastname: Schootman
authors.forename: B A
authors.initials: BA
authors.lastname: Evanoff
authors.forename: J S
authors.initials: JS
authors.lastname: Perlmutter
authors.forename: B A
authors.initials: BA
authors.lastname: Racette
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D016344:Medicare Part A; D016345:Medicare Part B; D009462:Neurology / Q000379:methods*; D010300:Parkinson Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D005791:Patient Care / Q000379:methods* / Q000706:statistics & numerical data*; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000078329:Workforce