Relationship between Claims-Based Frailty Index and Eye Care Utilization among Medicare Beneficiaries with Glaucoma.
Halawa Omar A, Kang Joyce, Parikh Ayush A, Oh Gahee, Glynn Robert J, Friedman David S, Kim Dae Hyun, Zebardast Nazlee
AI Summary
Frail Medicare glaucoma patients utilize less outpatient eye care (e.g., tests, surgery) but more acute/inpatient care, suggesting under-monitoring and delayed interventions for their glaucoma.
Abstract
Purpose
To determine differences in eye care utilization by frailty levels among Medicare beneficiaries with glaucoma.
Design
Retrospective cohort study.
Participants
Medicare fee-for-service beneficiaries over 65 years of age with glaucoma, identified using International Classification of Diseases codes before July 1, 2014.
Methods
By using a validated claims-based frailty index (range, 0-1), beneficiaries were classified as nonfrail/prefrail (0-0.19), mildly frail (0.20-0.29), and moderate-to-severely frail (≥ 0.30). Negative binomial regression analyses were used to estimate incident rate ratios (IRRs) of eye care utilization by frailty levels between July 1, 2014, and December 31, 2016.
Main outcome measures
Current Procedural Terminology codes for eye examinations and eye care-related office visits; eye care-related inpatient and emergency department (ED) encounters; eye care-related nursing facility and home-visit encounters; visual field (VF) and retinal nerve fiber layer (RNFL) OCT tests; and selective laser trabeculoplasties (SLTs) and glaucoma surgeries.
Results
Among 76 260 Medicare beneficiaries with glaucoma, the mean age was 78.9 years (standard deviation, 7.8), female beneficiaries constituted 60.5%, and 78.7% of beneficiaries self-identified as non-Hispanic White. According to a claims-based frailty index, 79.5% of beneficiaries were nonfrail/prefrail, 17.1% were mildly frail, and 3.4% were moderate-to-severely frail. Moderate-to-severely frail beneficiaries were less likely than nonfrail/prefrail beneficiaries to have outpatient encounters (IRR, 0.85, 95% confidence interval [CI], 0.83-0.88); VF tests (IRR, 0.64, 95% CI, 0.60-0.67); RNFL OCT tests (IRR, 0.77, 95% CI, 0.73-0.81); SLT (IRR, 0.74, 95% CI, 0.60-0.92); and glaucoma surgery (IRR, 0.74, 95% CI 0.55-0.99), after adjusting for age, gender, glaucoma severity, race, and socioeconomic status. Compared with nonfrail/prefrail beneficiaries, moderate-to-severely frail beneficiaries had higher rates of inpatient/ED encounters (IRR, 5.03, 95% CI, 2.36-10.71) and nursing facility/home-visit encounters (IRR, 34.89, 95% CI, 14.82-82.13).
Conclusions
Compared with nonfrail/prefrail Medicare beneficiaries with glaucoma, beneficiaries with moderate-to-severe frailty had lower rates of eye care utilization in the outpatient setting and higher rates of utilization in acute care settings. This suggests that frail patients may receive less disease monitoring and fewer interventions for their glaucoma management.
Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.
MeSH Terms
Shields Classification
Key Concepts4
Moderate-to-severely frail Medicare beneficiaries with glaucoma were less likely than nonfrail/prefrail beneficiaries to have outpatient encounters (IRR, 0.85, 95% confidence interval [CI], 0.83-0.88), visual field (VF) tests (IRR, 0.64, 95% CI, 0.60-0.67), retinal nerve fiber layer (RNFL) OCT tests (IRR, 0.77, 95% CI, 0.73-0.81), selective laser trabeculoplasties (SLTs) (IRR, 0.74, 95% CI, 0.60-0.92), and glaucoma surgery (IRR, 0.74, 95% CI 0.55-0.99), after adjusting for age, gender, glaucoma severity, race, and socioeconomic status.
Compared with nonfrail/prefrail Medicare beneficiaries with glaucoma, moderate-to-severely frail beneficiaries had higher rates of inpatient/emergency department (ED) encounters (IRR, 5.03, 95% CI, 2.36-10.71) and nursing facility/home-visit encounters (IRR, 34.89, 95% CI, 14.82-82.13).
Among 76,260 Medicare beneficiaries with glaucoma, the mean age was 78.9 years (standard deviation, 7.8), female beneficiaries constituted 60.5%, and 78.7% of beneficiaries self-identified as non-Hispanic White.
Among 76,260 Medicare beneficiaries with glaucoma, 79.5% were nonfrail/prefrail, 17.1% were mildly frail, and 3.4% were moderate-to-severely frail, according to a claims-based frailty index.
Related Articles5
Costing a community based screening programme for the detection of glaucoma.
Observational StudyLarge Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance.
Cohort StudySemi-automated screening reveals patients with glaucoma-induced blindness missing out on social support: a cross-sectional study of certificate of visual impairment allocation.
Cross-Sectional StudyTime to Glaucoma Progression Detection by Optical Coherence Tomography in Individuals of African and European Descents.
Cohort StudyRelationship between Neighborhood-Level Social Risk Factor Measures and Presenting Glaucoma Severity Utilizing Multilevel Modeling.
Cross-Sectional StudyIs this article assigned to the wrong chapter(s)? Let us know.