Determining the impact of specialized care on health outcomes and health care utilization in Parkinsonism

Conrad J Goerz; Anish Kanungo; Lisa M Lix; William D Leslie; Charles Burchill; Douglas E Hobson

doi:10.1016/j.parkreldis.2024.106026

Determining the impact of specialized care on health outcomes and health care utilization in Parkinsonism

Parkinsonism Relat Disord. 2024 Feb 10:106026. doi: 10.1016/j.parkreldis.2024.106026. Online ahead of print.

Authors

Conrad J Goerz¹, Anish Kanungo², Lisa M Lix³, William D Leslie⁴, Charles Burchill⁵, Douglas E Hobson⁶

Affiliations

¹ Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada.
² Division of Neurology, Department of Medicine, University of British Columbia, Canada.
³ Department of Community Health Sciences, University of Manitoba, Canada.
⁴ Department of Internal Medicine, University of Manitoba, Canada.
⁵ Manitoba Centre for Health Policy, University of Manitoba, Canada.
⁶ Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada. Electronic address: douglas.hobson@umanitoba.ca.

PMID: 38369425
DOI: 10.1016/j.parkreldis.2024.106026

Abstract

Background: Although care of Parkinsonism (PKM) is assumed to be optimally provided by movement disorder neurologists within an interdisciplinary clinic model, there is a paucity of published data to support this.

Objectives: To investigate the impact of movement disorder neurologist care of individuals with Parkinsonism (PKM).

Methods: A retrospective exposure design was adopted using administrative data. Incident PKM individuals were identified in billing claims. A nine-year exposure period to movement disorder neurologist, general neurologist and non-neurologist care was calculated based on the billing codes. Regression models were used to test the association of provider exposure on time to death and long-term care (LTC) admission. Linear models were used to test varying provider exposure and hospital admissions, hospital days and emergency department visits.

Results: 1914 incident individuals were identified. There was no difference in PKM mortality, emergency visits, hospital admissions, or hospital days between providers, however exposure to general neurology and non-neurology care was associated with a significantly higher risk of admission to LTC compared to movement disorder neurologist care (HR 1.43; 95% CI 1.09-1.87 for general neurology (p-value = 0.0089); HR 1.61; 95% CI 1.25-2.05 for non-neurology (p-value = 0.0002), respectively.

Conclusion: Movement disorder neurologist care is associated with a lower risk of admission to LTC over general neurologist care in individuals with PKM.

Keywords: Health care outcomes; Interdisciplinary care; Models of care; Movement disorders; Parkinson disease; Parkinsonism.