title: Mobility, mood and site of care impact health related quality of life in Parkinson's disease.
abstract: OBJECTIVE
  Examine the correlates of Health Related Quality of Life (HRQL) in a large cohort of Parkinson's disease (PD) patients from National Parkinson Foundation (NPF) Centers of Excellence (COEs).
  
  
  BACKGROUND
  Improving outcomes for PD will depend upon uncovering disease features impacting HRQL to identify targets for intervention and variables for risk-adjustment models. Differences in HRQL outcomes between COEs could uncover modifiable aspects of care delivery.
  
  
  METHODS
  This cross-sectional study examined the relative contribution of demographic, social, clinical and treatment features potentially related to HRQL, as measured by the PDQ-39, in 4601 consecutive subjects from 18 COEs. Stepwise linear regression was utilized to identify correlates of HRQL.
  
  
  RESULTS
  The variability in the PDQ-39 summary index score correlated with H&Y stage (R(2) = 22%), Timed up and Go (TUG) (17%), disease duration (11%), comorbidities (8%), cognitive status (8%), antidepressant use (6%) and center at which a patient received care (5%). Stepwise regression reordered the importance of the variables, with the H&Y first and TUG and the center becoming equal and the second most important variables determining the PDQ-39 total score. All independent variables together accounted for 44% of the variability in HRQL.
  
  
  CONCLUSIONS
  We confirmed many but not all HRQL associations found in smaller studies. A novel observation was that the site of care was an important contributor to HRQL, suggesting that comparison of outcomes and processes among centers may identify best practices.
authors.affiliation: Oregon Health & Science University, USA. Electronic address: nuttj@ohsu.edu.
authors.forename: J G
authors.initials: JG
authors.lastname: Nutt
authors.affiliation: University of Pennsylvania, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Siderowf
authors.affiliation: University of Toronto, USA.
authors.forename: M
authors.initials: M
authors.lastname: Guttman
authors.affiliation: National Parkinson Foundation, USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Schmidt
authors.affiliation: National Parkinson Foundation, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Zamudio
authors.affiliation: University of Florida, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: National Parkinson Foundation, USA; University of Florida, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Northwestern University, USA.
authors.forename: T
authors.initials: T
authors.lastname: Simuni
authors.affiliation: Struthers Parkinson Center, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Parashos
authors.affiliation: University of Pennsylvania, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Dahodwala
authors.affiliation: Vanderbilt University, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Davis
authors.affiliation: Tel Aviv Sourasky Medical Center, USA.
authors.forename: N
authors.initials: N
authors.lastname: Giladi
authors.affiliation: Tel Aviv Sourasky Medical Center, USA.
authors.forename: T
authors.initials: T
authors.lastname: Gurevich
authors.affiliation: University of South Florida, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Hauser
authors.affiliation: Baylor College of Medicine, USA.
authors.forename: J
authors.initials: J
authors.lastname: Jankovic
authors.affiliation: University of Kansas, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Lyons
authors.affiliation: DeBakey Veterans Affairs Medical Center, USA.
authors.forename: L
authors.initials: L
authors.lastname: Marsh
authors.affiliation: Toronto Western University, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Miyasaki
authors.affiliation: Georgia Regents University, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Morgan
authors.affiliation: Muhammad Ali Parkinson Center, USA; Barrow Neurological Institute, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Santiago
authors.affiliation: Beth Israel Medical Center, USA.
authors.forename: D
authors.initials: D
authors.lastname: Tarsy
authors.affiliation: Johns Hopkins Medical Center, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Mari
authors.affiliation: University of Florida, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Malaty
authors.affiliation: Dartmouth-Hitchcock Medical Center, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010044:Outpatient Clinics, Hospital / Q000592:standards; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*
keywords: Best practices; Health related quality of life; Parkinson's disease; Quality improvement