Objective: To identify center-level variations in Parkinson’s disease (PD) treatment practices and outcomes, and the relationship between treatment and outcomes to inform best practices

Background: There are a wide range of disease trajectories and outcomes in PD. However, it is unclear to what extent treatment practices influence outcomes

Method: We used data from the Parkinson Foundation Parkinson Outcomes Project, a longitudinal, observational study of individuals with PD seen at PF Centers of Excellence. Participants complete annual assessments of medication use, physical therapy referral and receipt of deep brain stimulation (DBS) surgery. Outcome assessments include health related quality of life (Parkinson Disease Questionnaire; PDQ-39) and fall frequency. After adjustment for age, sex, education and number of comorbidities we compared a single center’s PD treatment and patient outcomes to the mean value for all centers stratified by disease duration ≤5 and >5 years. A p-value < 0.05 was considered significant

Results: 12,664 PD participants with a mean age 68 (sd 10) and 63% men across 31 PF centers were studied. In disease duration ≤ 5 years, an average of 76% (n=4603) participants were taking levodopa with 7 centers at a significantly higher (82-95%) and 7 centers at a lower proportion (59-74%), and 35% (n=2143) were sent to physical therapy with 9 centers higher (39-71%) and 8 centers lower (13-27%) than the center average. PDQ-39 scores were 20 (sd 14) with 8 centers higher (21-27) and 6 centers lower (14-18) and 22% (n=1331) participants had falls with 8 centers higher (28-38%) and 6 centers lower (6-16%) than the center average. In disease duration > 5 years, 40% (n=2603) were sent to physical therapy with 8 centers higher (48-66%) and 10 centers lower (23-34%), and 20% (n=1251) had received DBS with 12 centers higher (22-41%) and 8 centers lower (2-10%) than the center average. PDQ-39 scores were 29 (sd 16) with 7 centers higher (30-36) and 7 centers lower (23-27) and 46% (n=2789) participants had falls with 7 centers higher (47-59%) and 8 centers lower (25-38%) than the center average

Conclusion: There is substantial variation in both PD treatment practices and patient outcomes across centers of excellence. We plan to identify treatment practices that are associated with better outcomes to help guide high quality clinical care

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MDS Abstracts - https://www.mdsabstracts.org/abstract/practice-and-outcome-variation-across-parkinsons-foundation-centers-of-excellence/