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theses

BACKGROUND: Parkinson’s Disease (PD) is the second most common neurodegenerative disease found in geriatric patients. It entails heavy burden to patients and governments in terms of high expenditures of medical services, insurance and poor quality of life. The objective of this study was to investigate the hospitalization characteristics of PD inpatients and determine the predictors and their interactive effects on the length of hospital stay (LOS), total charges and in-hospital mortality. METHOD: This study utilized the Nationwide Inpatient Sample (NIS) for the years 2007 to 2012. The data contained patients' demographic characteristics like age, gender, race, insurance type, and income. Also, the data involved other health variables like types and number of comorbidities, number of procedures, admission types, and type of PD. The SPSS statistical analysis software was used to analyze the NIS data of PD, where all outcomes with p values less than 0.05 were considered significant. Multinomial Logistic Regression and Multiple Linear Regression techniques were used to detect significant predictors of study outcomes. RESULTS: Descriptive analysis of this study showed the highest incidence of PD in geriatric patients as being White, Males, and patients on Medicare who were primarily emergency admissions. Males were more likely to have both major and extreme loss of function and major and extreme likelihood of dying. The latter was observed even for in-hospital mortality (i.e. higher risk for in hospital mortality). Blacks were seen to have higher odds of loss of function and likelihood of dying. In hospitality mortality didn’t reveal the same risk. Length of Stay is seen to decrease over the years 2007 to 2012 – this could possibly be due to improved care and procedures requiring lesser stay in the hospital. Mortality is also seen to decrease over the same period again possibly due to improved care and procedures. However total costs are on a rising trend indicating the increasing cost per discharge (which has remained same over the years on average) possibly due to the more newer and costly procedures. Advanced age was the main predictor of mortality more than other health predictors confirming the age associated aspects of Parkinson’s Disease as has been corroborated by innumerable studies in literature. Mortality is also seen to decrease over the same period (2007-2012) again possibly due to improved care and procedures. Since most of the admissions are through the Emergency Room there exists the possibility of complications leading to mortality. CONCLUSION: The study revealed several significant results related to hospitalization outcomes of Parkinson’s disease patients. Age (65 and above) was observed to be a major hospitalization factor for PD patients and the most significant factor for in hospital mortality. Certain comorbidities (CHF, fluid/electrolyte disorders, metastases, and weight loss) were found to augment the risk of mortality of the PD patients. Although Length of Stay (LOS) is on the decrease over the years of our study yet the median LOS is at least 1 day longer than average most possibly due to age related complications requiring longer hospital stay. Also possibly due to the increased number of procedures the Total Charges per PD patient is seen to be on the increase. This study corroborates the idiopathic nature of the Parkinson’s Disease even for the hospitalized patients though the information on LOS and Total Charges could be employed for better resource management of such patients. The results from this study would be highly beneficial to hospital administrators, insurance providers, patients and their caregivers.

ETD_8570

Ph.D.

Includes bibliographical references

by Amal Abdullah Almusharraf

doi:10.7282/T3ZS30RQ

ETD doctoral

The author owns the copyright to this work.