Purpose

To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries.

Design

Retrospective, claims-based analysis.

Participants

A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015.

Methods

Dementia was identified from diagnosis codes documented in a beneficiary’s first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities.

Main Outcome Measures

Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters).

Results

A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69–0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55–0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62–0.63) and less likely to receive a cataract diagnosis (18% vs. 82%).

Conclusions

US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.

中文翻译：

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患有和未患有痴呆症的 Medicare 受益人接受眼保健服务的情况。

目的

调查美国医疗保险受益人的痴呆状况与接受眼科护理之间的关系。

设计

回顾性的、基于索赔的分析。

参加者

在 2006 年 1 月 1 日至 2015 年 12 月 31 日期间接受护理的 20% 的 Medicare 受益人代表性样本。

方法

痴呆症是根据受益人在观察到的 Medicare 注册的前 3 年中记录的诊断代码确定的。眼保健就诊是根据每次就诊索赔的提供者专业代码确定的。我们使用具有时变协变量的多变量 Cox 比例风险回归模型来比较患有和未患有痴呆症的受益人接受眼保健的可能性。所有模型都针对潜在的混杂因素进行了调整，包括人口统计学、城市/农村居住地、全身健康（查尔森指数）和眼部合并症。

主要观察指标

(1) 被任何眼科保健提供者（眼科医生或验光师）看诊的风险比 (HR) 和 95% 置信区间 (CI)；(2) 由眼科医生专门看诊；(3) 接受白内障手术（在与眼科医生会面的受益人中）。

结果

共有 4 451 200 名受益人符合纳入标准；3 805 718 人（85.5%）在研究期间接受了眼科护理，391 556 人（8.8%）被诊断为痴呆症。在研究期间，大约 73.4% 的被诊断患有痴呆症的受益人去看了眼科保健人员，55.4% 的人去看了眼科医生，而没有诊断出痴呆症的受益人分别有 86.7% 和 74.0%。与未诊断为痴呆症的受益人相比，诊断为痴呆症的受益人看眼科护理人员的可能性较低（调整后的 HR，0.69；95% CI，0.69–0.70），看眼科医生的可能性也较低（调整后的 HR，0.55；95%）置信区间，0.55–0.55）。在看过眼科医生的受益人子集中，那些被诊断为痴呆症的受益人接受白内障手术的可能性也低于没有被诊断为痴呆症的受益人（HR，0.62；95% CI，0.

结论

与未确诊痴呆症的人相比，被诊断患有痴呆症的美国医疗保险受益人接受眼科护理的可能性更低。根据视力和功能状态，这可能会对伤害预防、身体和认知功能以及生活质量产生影响。需要进一步开展工作以确定接受眼保健的障碍，确定为痴呆症患者提供最大价值的眼保健服务和环境，并采取措施改善获得适当眼保健的机会。