Effect of integrated community neurology on utilization, diagnostic testing, and access

Elrashidi, Muhamad Y.; Philpot, Lindsey M.; Young, Nathan P.; Ramar, Priya; Swanson, Kristi M.; McKie, Paul M.; Crane, Sarah J.; Ebbert, Jon O.

doi:10.1212/cpj.0000000000000378

Cited by 11 publications

(15 citation statements)

References 33 publications

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“…The care model of integrated neurology co-located within a primary care medical home has been associated with reduced brain MRI utilization in a general neurology practice (17). This practice was also shown to utilize neuroimaging less than the traditional tertiary neurology practice at our institution (34). This practice model provides timely access to neurological expertise for primary care teams via telephone curbside discussion, electronic consultations, and triage of face-to-face visits.…”

Section: Discussionmentioning

confidence: 97%

Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags

et al. 2018

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Background Neuroimaging for headache commonly exceeds published guideline recommendations and may be overutilized. Methods We conducted a retrospective cross-sectional study of all outpatient community patients at Mayo Clinic Rochester who underwent a neuroimaging study for a headache indication in 2015. We assessed the neuroimaging utilization pattern, clinical application of red flags, and concordance with neuroimaging guidelines. Results We identified 190 outpatients who underwent 304 neuroimaging studies for headache. The median age was 46.5 years (range 18-91 years), 65% were female, and most reported no prior history of headache (n = 97, 51%). A minority of patients had prior brain imaging studies (n = 44, 23%) and neurological consultations for headache (n = 29, 15%). Few studies were ordered after consultation with a neurologist (n = 14, 7%). Seventy-seven percent of patients were documented to have a "red flag" justifying the imaging study. Abnormal neuroimaging findings were found in 3.1% of patients with warning flags (5/161); carotid dissection (n = 3) and reversible cerebral vasoconstrictive syndrome (n = 2). An estimated 35% of patients were imaged against guidelines. Conclusions The prevalence of serious causes of headache in a community practice was low despite the presence of a documented red flag symptom. Inadequate understanding or application of red flags may be contributing to recommendations to image patients against current guidelines. Interventions to reduce unnecessary neuroimaging of patients with headache need to be designed and implemented.

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Section: Discussionmentioning

confidence: 97%

Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags

et al. 2018

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“…5 Our findings are also similar to observations we made with an integrated ICS-neurology model which observed decreases in standard neurology referrals. 10 Additionally, we anticipate that our ICS-GI availability via telephone and eConsult service, unmeasured in the current study, also facilitates decreased utilization of our GI referral practice; thereby, our findings may be underestimating the true impact of our ICS-GI model on referrals to our GI referral practice. Our findings provide additional information that an ICS-GI model can reduce time to face-to-face consultations when the specialist is embedded within the primary care practice.…”

Section: Discussionmentioning

confidence: 84%

Effect of Integrated Gastroenterology Specialists in a Primary Care Setting: a Retrospective Cohort Study

et al. 2020

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BACKGROUND: Gastrointestinal (GI) complaints are common in primary care practices. The patient-centered medical home (PCMH) may improve coordination and collaboration by facilitating coordination across healthcare settings and within the community, enhancing communication between providers, and focusing on quality of care delivery. OBJECTIVE: To investigate the effect of integrated community gastroenterology specialists (ICS-GI) model within a large primary care practice. DESIGN: Retrospective cohort with propensity-matched historic controls. PATIENTS: We identified 265 patients who had a visit with one of our ICS-GI specialists and matched them (1:2) to 530 similar patients seen prior to the implementation of the ICS-GI model. MAIN MEASURES: Frequency of diagnostic testing for GI indications, visits to our outpatient GI referral practice, emergency department and hospital utilization, and time to access of specialty care for the whole population and by GI condition group. KEY RESULTS: Patients seen in our ICS-GI model had similar outpatient care utilization (OR = 1.0, 95% CI 0.7-1.4, p = 0.90), were more likely to have visits in primary care (OR OR=1.5, 95% CI 1.1-2.2, p = 0.02), and were less likely to have visits to our GI outpatient referral practice (OR = 0.3, 95% CI 0.2-0.7, p < 0.0001). Condition-specific analyses show that all GI conditions experienced decreased visits to the outpatient GI referral practice outside of patients with GI neoplasm. Populations did not differ in emergency department, hospital, or diagnostic utilization. CONCLUSIONS: We observed that an embedded specialist in primary care model is associated with improved care coordination without compromising patient safety. The PCMH could be extended to include subspecialty care.

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“…These findings help to support our previous observations that the ICN model including primary care-neurology collaboration is associated with safe reduction of face-to-face neurology visits and diagnostic testing. 1,9 Unlike the pilot study of the ICN model, this study uniquely highlights synchronous collaboration including a video option for PCP but does not include further assessment of asynchronous collaboration, which remains a major part of the ICN practice. Was this your first video consult?…”

Section: Discussionmentioning

confidence: 99%

Synchronous neurology–primary care collaboration in a medical home

et al. 2020

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BackgroundSynchronous collaboration as defined by a simultaneous encounter between primary care providers (PCPs), patients, and neurologists may improve access to neurologic expertise, care value, and satisfaction of PCPs and patients. We examined a series of synchronous collaborations and report outcomes, PCP satisfaction, downstream utilization, and illustrative case examples.MethodsWithin an outpatient collaborative primary care–neurology care model, we implemented synchronous video consultations from a central hub to satellite clinics while increasing availability of synchronous telephone and face-to-face collaboration. PCP experience was assessed by a postcollaboration survey. Individual cases were summarized. Clinical and utilization outcomes were assessed by a neurologist immediately after and by follow-up chart review.ResultsA total of 58 total synchronous collaborations were performed: 30 by telephone (52%), 18 face to face (31%), and 10 by video (17%) over 27 clinic half-days. The most frequent outcomes as assessed by the neurologist were reassurance of the PCP (23/58; 40%) and patient (22/59; 38%), and the neurologist changed the treatment plan (23/58; 40%). A subsequent face-to-face consultation was completed in 15% (6/58) of patients initially assessed by telephone or video. Test utilization was avoided in 40% (23/58). Unintended utilization occurred 9% (5/58). Most PCPs were very satisfied with the ease of access, quality of care, and reported high likelihood of subsequent use. PCPs perceived similar or less time spent during synchronous vs asynchronous collaboration and neurologist usually altered the testing (87.8%) and treatment plan (95.2%).ConclusionsSynchronous collaboration between neurologists and PCPs may improve timely access to neurologic expertise, downstream utilization, and PCP satisfaction.

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Effect of integrated community neurology on utilization, diagnostic testing, and access

Cited by 11 publications

References 33 publications

Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags

Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags

Effect of Integrated Gastroenterology Specialists in a Primary Care Setting: a Retrospective Cohort Study

Synchronous neurology–primary care collaboration in a medical home

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