Integrative Analysis of Predictors for Unfavorable Course of Parkinson Disease According to Medical Care Assessment: Cohort Retrospective Study

Abstract

Background. Parkinson's disease is a neurodegenerative disorder that leads to severe disability, especially in its advanced stages. Medical care should be performed in accordance with modern clinical recommendations and standards. Assessment of the quality of medical care in the Russian Federation is carried out via examination of medical documentation by insurance experts regarding compliance with Russian standards and other regulatory documents.Objective. To study the predictors for unfavorable course of Parkinson's disease based on routine examinations of the quality of medical care.Methods. The cohort retrospective study included 7,264 examinations of the medical care quality of 1,754 patients with Parkinson's disease for the period from 2011 to 2018 in the Russian Federation. The study focused on two indicators: presence/absence of disease progression and determination/aggravation of a degree of disability or maintenance of the previous social and professional activity. The obtained data were used to develop diagnostic tables with prognostic factors of Parkinson's disease according to A. Wald. Statistical analysis of the results was carried out using Statistica 13 (StatSoft, USA). Results. Diagnostic tables have been developed to determine the prognostic factors affecting the progression of Parkinson's disease and, accordingly, decreasing the degree of social and/ or professional activity and to assess the diagnostic factors when the risk of the disease aggravation will be more than 95%.Conclusion. The greatest progression of Parkinson's disease (p < 0.05) was observed in the cases of poor collection of complaints, history and clinical evaluation of the patient's condition, inadequate prescription or absence of prescription of levodopa when indicated, as well as defects in the correction of additional disorders. The likelihood of social disadaptation in patients with Parkinson's disease (p < 0.05) was found to be greater in the cases of poor collection of complaints and history, neurological examination and clinical evaluation of the patient's condition as well as inadequate prescription or absence of prescription of levodopa when indicated.