Pilot of integrated, colocated neurology in a primary care medical home

Young, Nathan P.; Elrashidi, Muhamad Y.; Crane, Sarah J.; Ebbert, Jon O.

doi:10.1111/jep.12667

Cited by 17 publications

(36 citation statements)

References 27 publications

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“…Qualitative studies are needed to better understand the dissatisfaction of CM patients in particular. These findings will be used to further develop and study triage along care pathways within our current Integrated Community Neurology practice model in which neurologists are co‐located with primary care teams and utilize electronic consultations, curbside telephone consultations, and face‐to‐face visits. Although approximately 25% of patients in this practice have headache, we have not yet developed nor studied a specific care pathway for migraine patients.…”

Section: Discussionmentioning

confidence: 99%

“…This finding supports further consideration and study of the possibility that our population may struggle with the stigma of migraine and whether stigma may be a barrier to seeking better care for migraine. Educating our trainees, referring providers, care teams, and adapting our clinical education and future care models to use destigmatizing language is suggested …”

Section: Discussionmentioning

confidence: 99%

“…All patients aged 18 years or older with any migraine‐specific ICD‐9 or ICD‐10 diagnosis code between May 1, 2014 and April 1, 2017 within the Mayo Clinic Employee and Community Health practice in Rochester, MN were identified. The Employee and Community Health practice is comprised of Internal Medicine, Family Medicine, and Integrated Community Specialists (including Neurology) serving the primary care needs of 155,000 individuals residing in Olmsted County and adjacent communities. We identified a total of 5239 migraine patients based on ICD‐9 and ICD‐10 diagnosis code.…”

Section: Methodsmentioning

confidence: 99%

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Episodic and Chronic Migraine in Primary Care

et al. 2019

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Objective.-To inform migraine care model development by assessing differences between patients with chronic migraine (CM) and episodic migraine (EM) in the current state of treatment, disability, patient satisfaction, and quality improvement opportunities.Background.-Efficient and focused use of scarce resources will be needed to address challenges within large populations of migraine patients.Methods.-We deployed a cross-sectional survey study of randomly selected migraine patients within a community primary care practice.Results.-There were 516 survey respondents (516/1804 [30%] response rate). CM patients were more likely than EM patients to report care from a neurologist (76/110 [69%] vs 229/406 [56%]; P = .0026), and higher disability according to the Migraine Disability Assessment and Headache Impact Test -6 questionnaires (P < .0001). CM patients were less likely than EM patients to report overall satisfaction with care (16/110 [38%] vs 156/406 [66%], P = .0002), satisfaction with access to care (17/110 [33%] vs 176/406 [68%], P < .0001), and advice they needed (16/110 [31%] vs 160/406 [62%], P < .0001). Most patients with migraine had been offered triptan medications 377/516 (78%). Overall, 156/516 (31%) of individuals were currently taking any medication for migraine prevention, and 208/516 (40%) including botulinum toxin injections. CM patients were more likely to be taking preventive medication (39/110 [36%] vs 117/406 [29%], P = .0191) and report familiarity with the diagnosis of medication-overuse headache than patients with EM (80/110 [81%] vs 256/406 [69%], P = .0178).Conclusions.-We observed differences between patients with chronic and EM and expected care delivery improvement opportunities for migraine patients in primary care. CM patients report higher levels of disability and less satisfaction with access to perceived needed medical advice and care. These findings support the need to further develop and study novel care models to efficiently and effectively deliver high-quality care and expertise in limited supply to a diverse migraine population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Episodic and Chronic Migraine in Primary Care

et al. 2019

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“…The ICN model has been described previously. 14 Prior to implementation of ICN, the Mayo Clinic non-colocated neurology referral practice provided neurology consultation and longitudinal care for ECH as well as regional, national, and international patients. Beginning October 1, 2014, a 0.6 full-time equivalent (FTE) neurologist was colocated within the main ECH practice site.…”

Section: Methodsmentioning

confidence: 99%

“…ICN demonstrated avoidance of diagnostic testing at a median of 6 months follow-up, reduced PCP referrals for face-to-face consultation to both ICN and non-colocated neurology, and safety. 14 However, the benefit of ICN over a longer period and its effect on other utilization patterns remains unknown.…”

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confidence: 99%

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

et al. 2017

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Background:The primary care medical home (PCMH) aims to promote delivery of high-value health care. However, growing demand for specialists due to increasingly older adults with complicated and chronic disease necessitates development of novel care models that efficiently incorporate specialty expertise while maintaining coordination and continuity with the PCMH. We describe the effect of a model of integrated community neurology (ICN) on health care utilization, diagnostic testing, and access.Methods:This is a retrospective, matched case-control comparison of patients referred to ICN for a face-to-face consultation over a 12-month period. The control group consisted of propensity score–matched patients referred to a non-colocated neurology practice during the study period. Administrative data were used to assess for diagnostic testing, visit utilization, and patient time to appointment.Results:From October 1, 2014, to September 30, 2015, we identified 459 patients evaluated by ICN for a face-to-face visit and 459 matched controls evaluated by the non-colocated neurology practice. The majority of patients were Caucasian and female. ICN patients had lower odds of EMGs ordered (adjusted odds ratio [OR] 0.64; 95% confidence interval [CI] 0.46–0.89; p = 0.009), MRI brain (adjusted OR 0.60; 95% CI 0.45–0.79; p = 0.0004), or subsequent referral to outpatient neurology (adjusted OR 0.62; 95% CI 0.47–0.83; p = 0.001). ICN was not associated with an increase in emergency department visits, hospitalizations, or appointment wait time.Conclusions:The ICN model in a PCMH has the potential to reduce diagnostic testing and utilization.

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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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Pilot of integrated, colocated neurology in a primary care medical home

Abstract: Colocated neurology in a primary care medical home offers a promising intervention to deliver high-value care.

Cited by 17 publications

References 27 publications

Episodic and Chronic Migraine in Primary Care

Episodic and Chronic Migraine in Primary Care

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

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

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