PINC AI™ Data: Need for Better Parkinson’s Disease Care Coordination

Key takeaways:

• PINC AI^™ Healthcare Data (PHD) analysis revealed that the annual total cost of care for all Parkinson’s disease (PD) patients during calendar year 2021 was $1.6 billion dollars with 75 percent of that amount attributed to acute inpatient care.
• PHD data shows that, while Parkinson’s patients aren’t coming to the hospital for PD specific treatment, they are coming to the hospital for treatment of complications of PD.
• PINC AI^™ Applied Sciences’ (PAS) Brain Memory Collaborative brings health systems and life sciences together to uncover and help solve clinical, operational and financial barriers to early identification, diagnosis and treatment.

In a two-part blog series on optimizing neurodegenerative disease care, the PAS team is providing insights on how to help better coordinate care for patients with Parkinson’s Disease (PD) and Alzheimer’s Disease (AD). In this post, we will discuss ways to optimize care for patients diagnosed with PD, and in the second post, we will focus on improving care for patients with AD.

On April 25, the PINC AI^™ Applied Sciences’ (PAS) Brain and Memory Collaborative (BMC) hosted a meeting to discuss care coordination for patients with neurodegenerative diseases. Topics included barriers impeding optimization of care pathways, adoption of guidelines, exploring the data needs to drive policy and innovation in reimbursement, and lack of access to care.

Diving Into Parkinson’s Disease PINC AI^™ Data

With guidance from Dr. Peter Pronovost, University Hospitals, Cleveland, during the PD breakout session, participants discussed data that highlighted patients that were admitted with a primary or a secondary diagnosis of PD.

The data showed that, while Parkinson’s patients weren’t being admitted to the hospital for treatment of PD, they were being admitted for treatment of complications related to their PD.

The analysis of PINC AI™ Healthcare Data (PHD), including 693,114 emergency department (ED) and inpatient encounters made by 474,470 unique patients with a diagnosis of PD from January 2018 through September 2022, found:

• Five percent of encounters had a principal discharge diagnosis for the treatment of PD.
• Ninety-five percent or 659,477 encounters had a secondary discharge diagnosis of PD.

This PHD data illuminates the impact point that patients with a secondary diagnosis of PD had far more ED and inpatient encounters than patients with a principal diagnosis of PD.

Further examination of principal discharge diagnosis revealed the top diagnoses as:

• Sepsis.
• Urinary tract infections.
• Falls or injuries related to a fall.

All of these are conditions that PD patients are prone to experiencing.

We also looked at the annual total cost of care for the calendar year 2021 and, for all PD patients, the cost was $1.6 billion dollars with 75 percent of that attributed to acute inpatient care.

While these figures are high, we also need to understand how these patients are arriving at the ED or inpatient setting and track their discharge disposition as this can also result in added healthcare expenditures.

The PHD data showed:

• Eighty percent of patients with either a principal or secondary discharge diagnosis of PD were coming to the ED or inpatient setting from their homes.
• Close to 50 percent of these PD patients were discharged or transferred to an acute care facility, skilled nursing facility, hospice or home health for further care.
  
  

Why it Matters

Patients with neurodegenerative disorders outside of the admitting diagnosis, like PD, face potential safety risks if such disorders are undetected at hospital admittance. For example, patients with PD require strict adherence to a timed medication regimen. If medications are not administered on time, according to the patient’s unique schedule, patients may experience an immediate increase in symptoms.

Additionally, these patients can be administered medications that counter the effects of their PD medications that may lead to complications, potentially longer lengths of stay and increased costs associated with continued care.

What They’re Saying about PD

It’s important for patients with PD and/or their caregivers to advocate for their care.

The Parkinson’s Foundation has developed Aware in Care hospital safety kits that allow patients and their caregivers to take an active role in helping them stay safe while hospitalized.

The kits are filled with useful tools and information to help a person with PD during their hospital visit, including a hospital action plan, hospital care fact sheet, medication form, medical alert card, Duopa info card or deep brain stimulation cards, and a letter that highlights the importance of adherence to their PD medication schedule.

Self-identification resources provide patients and caregivers with the tools to help advocate for safer care.

Collaboration Can Help Optimize Patient Care

The PAS BMC is committed to collaborating with partners to generate real-world insights and co-innovate new, clinical pathways that remove barriers impacting patient outcomes. Early identification of patients with PD can help clinicians provide treatment to help slow the progression of the disease.

In addition, the Parkinson’s Foundation has created the Parkinson’s Foundation Hospital Care Recommendations to improve hospital safety and eliminate preventable harm.

These recommendations outline five standards of care that can potentially improve hospital safety and provide tools that can help facilitate their implementation.

The five standards include:

• All Parkinson’s medications are ordered in a custom fashion, according to patients’ at-home regimen.
• All Parkinson’s medications are administered within ±15 minutes of patients’ at-home regimen, 100 percent of the time.
• Potentially harmful medication events are eliminated, particularly in dopamine-blocking medications, agents for pain and sedatives.
• All people with Parkinson’s should mobilize three times a day if clinically appropriate and under professional supervision if necessary.
• All people with Parkinson’s should undergo screening for dysphagia within 24 hours, with measures taken to minimize the risk of aspiration pneumonia, as needed.

These evidence-based recommendations can help health systems address deficiencies in PD patient care, yet further resources are needed to fully support hospitals and health systems to implement the recommendations, collect real-world evidence, and further demonstrate the impact of these interventions and related outcomes.

The implementation process is still a work in progress, and the Parkinson’s Foundation demonstrates their commitment to providing leadership, expanding evidence that supports the recommendations and supporting hospitals and health systems through their work to make changes in clinical care, management, culture, technology, education and policy related to making hospital care safer for patients with PD.

What Lies Ahead

The knowledge that neurodegenerative diseases begin years before the onset of symptoms provides insight into why such conditions are harder to prevent and treat. However, it also implies that there’s a window of time in which intervention can occur to change disease progression.

Improving the PD patient journey to diagnosis, preventing hospitalization and improving quality upon hospital admission are key factors of slowing the progression of PD and giving these patients a better quality of life.

“As we move forward in the field, we need to come together to help prevent, advocate, care and treat patients with PD,” said Michael S. Okun, MD, Executive Director of the Fixel Institute for Neurological Diseases and the National Medical Advisor for the Parkinson's Foundation. “We need to be companions that walk with these patients, help them navigate their PD journey and channel their energy away from worry and back into living.”

PAS and our partners are committed to this work and continue to advance research and develop technology-enabled tools to help health systems better prepare and improve their processes for managing and treating these vulnerable patient populations.

For more on this topic:

• Read more about PINC AI^™ Applied Sciences and explore our research and analytics solutions.
• For health systems or life sciences companies interested in joining the BMC, please contact us for more information.

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