Adherence to practice parameters in Medicare beneficiaries with amyotrophic lateral sclerosis
Osvaldo J Laurido-Soto,
Irene M Faust,
Susan Searles Nielsen and
Brad A Racette
PLOS ONE, 2024, vol. 19, issue 6, 1-17
Abstract:
Objective: Physician adherence to evidence-based clinical practice parameters impacts outcomes of amyotrophic lateral sclerosis (ALS) patients. We sought to investigate compliance with the 2009 practice parameters for treatment of ALS patients in the United States, and sociodemographic and provider characteristics associated with adherence. Methods: In this population-based, retrospective cohort study of incident ALS patients in 2009–2014, we included all Medicare beneficiaries age ≥20 with ≥1 International Classification of Diseases, Ninth Revision, Clinical Modification ALS code (335.20) in 2009 and no prior years (N = 8,575). Variables of interest included race/ethnicity, sex, age, urban residence, Area Deprivation Index (ADI), and provider specialty (neurologist vs. non-neurologist). Outcomes were use of practice parameters, which included feeding tubes, non-invasive ventilation (NIV), riluzole, and receiving care from a neurologist. Results: Overall, 42.9% of patients with ALS received neurologist care. Black beneficiaries (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.47–0.67), older beneficiaries (OR 0.964, 95% CI 0.961–0.968 per year), and those living in disadvantaged areas (OR 0.70, 95% CI 0.61–0.80) received less care from neurologists. Overall, only 26.7% of beneficiaries received a feeding tube, 19.2% NIV, and 15.3% riluzole. Neurologist-treated patients were more likely to receive interventions than other ALS patients: feeding tube (OR 2.80, 95% CI 2.52–3.11); NIV (OR 10.8, 95% CI 9.28–12.6); and riluzole (OR 7.67, 95% CI 6.13–9.58), after adjusting for sociodemographics. These associations remained marked and significant when we excluded ALS patients who subsequently received a code for other diseases that mimic ALS. Conclusions: ALS patients treated by neurologists received care consistent with practice parameters more often than those not treated by a neurologist. Black, older, and disadvantaged beneficiaries received less care consistent with the practice parameters.
Date: 2024
References: View references in EconPapers View complete reference list from CitEc
Citations:
Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0304083 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 04083&type=printable (application/pdf)
Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.
Export reference: BibTeX
RIS (EndNote, ProCite, RefMan)
HTML/Text
Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0304083
DOI: 10.1371/journal.pone.0304083
Access Statistics for this article
More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().