Monitoring visual status

Why patients do or do not comply with practice guidelines

Frank A. Sloan, Derek S. Brown, Emily Carlisle, Gabriel A. Picone, Paul P. Lee

Research output: Contribution to journalArticle

Abstract

Objective. To determine factors affecting compliance with guidelines for annual eye examinations for persons diagnosed with diabetes mellitus (DM) or age-related macular degeneration (ARMD). Data Sources/Study Setting. Nationally representative, longitudinal sample of individuals 65+ drawn from the National Long-Term Care Survey (NLTCS) with linked Medicare claims records from 1991 to 1999. Study Design. Medicare beneficiaries were followed from 1991 to 1999, unless mortality intervened. All claims data were analyzed for presence of ICD-9 codes indicating diagnosis of DM or ARMD and the performance of eye exams. The dependent variable was a binary indicator for whether a person had an eye exam or not during a 15-month period. Independent variables for demographics, living conditions, supplemental insurance, income, and other factors affecting the marginal cost and benefit of an eye exam were assessed to determine reasons for noncompliance. Data Collection/Extraction Methods. Panel data were created from claims files, 1991-1999, merged with data from the NLTCS. Principal Findings. The probability of having an exam reflected perceived benefits, which vary by patient characteristics (e.g., education, no dementia), and factors associated with the ease of visit. African Americans were much less likely to be examined than were whites. Conclusions. Having an exam reflects multiple factors. However, much of the variation in the probability of an exam remained unexplained as were reasons for the racial differences in use.

Original languageEnglish (US)
Pages (from-to)1429-1448
Number of pages20
JournalHealth Services Research
Volume39
Issue number5
DOIs
StatePublished - Oct 2004

Fingerprint

Practice Guidelines
monitoring
Macular Degeneration
Long-Term Care
International Classification of Diseases
Medicare
chronic illness
Diabetes Mellitus
marginal costs
human being
Information Storage and Retrieval
Social Conditions
living conditions
Insurance
dementia
African Americans
insurance
Cost-Benefit Analysis
Dementia
mortality

Keywords

  • Age-related macular degeneration
  • Compliance
  • Diabetes mellitus
  • Eye care
  • Practice guidelines

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Monitoring visual status : Why patients do or do not comply with practice guidelines. / Sloan, Frank A.; Brown, Derek S.; Carlisle, Emily; Picone, Gabriel A.; Lee, Paul P.

In: Health Services Research, Vol. 39, No. 5, 10.2004, p. 1429-1448.

Research output: Contribution to journalArticle

Sloan, Frank A. ; Brown, Derek S. ; Carlisle, Emily ; Picone, Gabriel A. ; Lee, Paul P. / Monitoring visual status : Why patients do or do not comply with practice guidelines. In: Health Services Research. 2004 ; Vol. 39, No. 5. pp. 1429-1448.
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