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Goerz CJ, Kanungo A, Lix LM, Leslie WD, Burchill C, Hobson DE. Determining the impact of specialized care on health outcomes and health care utilization in Parkinsonism. Parkinsonism Relat Disord 2024; 124:106026. [PMID: 38369425 DOI: 10.1016/j.parkreldis.2024.106026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although care of Parkinsonism (PKM) is assumed to be optimally provided by movement disorder neurologists within an interdisciplinary clinic model, there is a paucity of published data to support this. OBJECTIVES To investigate the impact of movement disorder neurologist care of individuals with Parkinsonism (PKM). METHODS A retrospective exposure design was adopted using administrative data. Incident PKM individuals were identified in billing claims. A nine-year exposure period to movement disorder neurologist, general neurologist and non-neurologist care was calculated based on the billing codes. Regression models were used to test the association of provider exposure on time to death and long-term care (LTC) admission. Linear models were used to test varying provider exposure and hospital admissions, hospital days and emergency department visits. RESULTS 1914 incident individuals were identified. There was no difference in PKM mortality, emergency visits, hospital admissions, or hospital days between providers, however exposure to general neurology and non-neurology care was associated with a significantly higher risk of admission to LTC compared to movement disorder neurologist care (HR 1.43; 95% CI 1.09-1.87 for general neurology (p-value = 0.0089); HR 1.61; 95% CI 1.25-2.05 for non-neurology (p-value = 0.0002), respectively. CONCLUSION Movement disorder neurologist care is associated with a lower risk of admission to LTC over general neurologist care in individuals with PKM.
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Affiliation(s)
- Conrad J Goerz
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada
| | - Anish Kanungo
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Charles Burchill
- Manitoba Centre for Health Policy, University of Manitoba, Canada
| | - Douglas E Hobson
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Canada.
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Wang SK, Goodrich RC, Strauss LD, Martindale JM. High-Yield, Case-Based, Interactive Workshop on Telehealth and Teleneurology With Pediatric Resident Physicians. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11340. [PMID: 37638232 PMCID: PMC10450098 DOI: 10.15766/mep_2374-8265.11340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023]
Abstract
Introduction Increasing prevalence of neurologic disorders with an aging global population and limited availability of neurologists may lead to worse patient outcomes. As a result of the COVID-19 pandemic, telehealth services surged, and despite easing public health measures, the demand has remained. Telehealth technology has the potential to close the physical gaps in expanding the reach of care. This academic half-day workshop sought to provide a learning opportunity in response to these concerns. Methods The workshop consisted of small- and large-group case discussions among pediatric resident physicians (PGY 1-PGY 3) moderated by two child neurology faculty physicians over Zoom. Participants received a learner document with prereading articles and questions for each case. PowerPoint presentations with video demonstrations were used to introduce the cases and guide discussions. Results Of the 25 attendees, 14 (56% response rate) answered a nonmandatory postsession survey. Eighty-six percent of the respondents were very or extremely satisfied with the content covered and were similarly satisfied with the effectiveness of content delivery. Seventy-nine percent of the respondents found the content helpful or very helpful in preparation for the board, and 93% anticipated applying the content covered occasionally or frequently in their clinical practice. Discussion Small-group discussions with video demonstrations are helpful in increasing proficiency with telehealth technology and in examining board-relevant cases on pediatric patients. There is strong interest in subsequent telehealth half-day workshops that incorporate teaching through group discussions on relevant patient case scenarios.
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Affiliation(s)
- Sean K. Wang
- Third-Year Medical Student, Wake Forest University School of Medicine
| | - Robert C. Goodrich
- Chief Resident, Department of Child Neurology, Atrium Health Wake Forest Baptist
| | - Lauren D. Strauss
- Associate Professor, Wake Forest University School of Medicine and Department of Neurology, Atrium Health Wake Forest Baptist
| | - Jaclyn M. Martindale
- Assistant Professor, Wake Forest University School of Medicine and Department of Neurology, Atrium Health Wake Forest Baptist
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3
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Chu NY, Watson KE, Al Hamarneh YN, Yushko L, Tsuyuki RT, Smyth P. Evaluating the impact of patient-reported outcome measures on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial. BMC Neurol 2023; 23:53. [PMID: 36732694 PMCID: PMC9893570 DOI: 10.1186/s12883-023-03090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease affecting multiple functional aspects of patients' lives. Depression and anxiety are common amongst persons with MS (PwMS). There has been an interest in utilizing patient-reported outcome measures (PROMs) to capture and systematically assess patient's perceptions of their MS experience in addition to other clinical measures, but PROMs are not usually collected in routine clinical practice. Therefore, this study aims to systematically incorporate periodic electronically administered PROMs into the care of PwMS to evaluate its effects on depression and anxiety. METHODS A randomized controlled trial will be conducted with patients allocated 1:1 to either intervention or conservative treatment groups. Patients in the intervention group will complete PROMs at the start of the study and then every 6 months for 1 year, in addition to having their MS healthcare provider prompted to view their scores. The conservative treatment group will complete PROMs at the start of the study and again after 12 months, and their neurologist will not be able to view their scores. For both groups, pre-determined critical PROM scores will trigger an alert to the patient's MS provider. The difference in change in Hospital Anxiety and Depression Scale score between the intervention and conservative treatment groups at 12 months will be the primary outcome, along with difference in Consultation Satisfaction Questionnaire and CollaboRATE scores at 12 months, and proportion and type of healthcare provider intervention/alerts initiated by different PROMs as secondary outcomes. DISCUSSION This study will determine the feasibility of utilizing PROMs on an interval basis and its effects on the psychological well-being of PwMS. Findings of this study will provide evidence on use of PROMs in future MS clinical practice. TRIAL REGISTRATION This trial is registered at the National Institutes of Health United States National Library of Medicine, ClinicalTrials.gov NCT04979546 . Registered on July 28, 2021.
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Affiliation(s)
- Nathan Y. Chu
- grid.17089.370000 0001 2190 316XDepartment of Medicine, Division of Neurology, University of Alberta, 7-132B Clinical Sciences Building, 8440 112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Kaitlyn E. Watson
- grid.17089.370000 0001 2190 316XEPICORE (Epidemiology Coordinating and Research) Centre, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Yazid N. Al Hamarneh
- grid.17089.370000 0001 2190 316XEPICORE (Epidemiology Coordinating and Research) Centre, Department of Medicine, University of Alberta, Edmonton, AB Canada ,grid.17089.370000 0001 2190 316XDepartment of Pharmacology, University of Alberta, Edmonton, AB Canada
| | - Lily Yushko
- grid.17089.370000 0001 2190 316XEPICORE (Epidemiology Coordinating and Research) Centre, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Ross T. Tsuyuki
- grid.17089.370000 0001 2190 316XEPICORE (Epidemiology Coordinating and Research) Centre, Department of Medicine, University of Alberta, Edmonton, AB Canada ,grid.17089.370000 0001 2190 316XDepartment of Pharmacology, University of Alberta, Edmonton, AB Canada ,grid.17089.370000 0001 2190 316XDepartment of Medicine, University of Alberta, Edmonton, AB Canada
| | - Penelope Smyth
- grid.17089.370000 0001 2190 316XDepartment of Medicine, Division of Neurology, University of Alberta, 7-132B Clinical Sciences Building, 8440 112 Street NW, Edmonton, AB T6G 2B7 Canada
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DeMarco EC, Zhang Z, Al-Hakeem H, Hinyard L. Depression After Parkinson's Disease: Treated Differently or Not At All? J Geriatr Psychiatry Neurol 2023; 36:39-51. [PMID: 35382620 DOI: 10.1177/08919887221090217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is a common, potentially debilitating non-motor symptom of Parkinson's disease which may manifest at any time and can respond to treatment. Although depression is a known primary mediator of health-related quality of life, it is currently unknown whether the timing of depression diagnosis relative to PD diagnosis affects receipt of depression treatment. Electronic health record data were examined to explore differences in depression treatment among patients diagnosed with depression before or after PD diagnosis. Compared to PD patients diagnosed with depression prior to PD, those diagnosed with depression following PD are less likely to receive any treatment, either pharmacologic or non-pharmacologic, indicating a temporal association between the time of PD diagnosis and receipt of depression treatment. This highlights a potentially substantial treatment gap, despite the existence of efficacious treatment. Diagnosis with PD appears to alter depression treatment and further research is warranted to determine potential causes and effective interventions.
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Affiliation(s)
- Elisabeth C DeMarco
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Zidong Zhang
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
| | - Haider Al-Hakeem
- 12274Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Leslie Hinyard
- Department of Health & Clinical Outcomes Research, 12274Saint Louis University School of Medicine, Saint Louis, MO, USA.,Advanced HEAlth Data (AHEAD) Institute, 12274Saint Louis University, Saint Louis, MO, USA
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Zwicker J, Qureshi D, Talarico R, Webber C, Watt C, Kim W, Milani C, Ramanathan U, Mestre T, Tanuseputro P. Dying with Parkinson's Disease: Healthcare Utilization and Costs in the Last Year of Life. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2249-2259. [PMID: 36120791 DOI: 10.3233/jpd-223429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson's disease (PD). OBJECTIVE The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital. METHODS Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life. RESULTS We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19- 0.30, and OR: 0.38, 95% CI: 0.33- 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001). CONCLUSION Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.
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Affiliation(s)
- Jocelyn Zwicker
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Colleen Webber
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Christine Watt
- The Ottawa Hospital, Division of Palliative Care, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Elisabeth Bruyère Hospital, Ottawa, ON, Canada
| | - WooJin Kim
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
| | | | - Usha Ramanathan
- Scarborough Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Tiago Mestre
- The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Mind and Brain Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- The Ottawa Hospital, Division of Palliative Care, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
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Soh EML, Neo S, Saffari SE, Wong ASY, Ganesan G, Li W, Ng HL, Xu Z, Tay KY, Au WL, Tan KB, Tan LCS. Longitudinal Healthcare Utilization and Costs in Parkinson's Disease: Pre-Diagnosis to 9 Years After. JOURNAL OF PARKINSON'S DISEASE 2022; 12:957-966. [PMID: 34974439 DOI: 10.3233/jpd-212982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is currently insufficient long-term data on costs of treatment in patients with Parkinson's disease (PD), which is chronic and progressive, and associated with substantial healthcare costs. Identifying patterns in healthcare utilization and cost may illuminate further discussion on early intervention. OBJECTIVE To characterize long-term healthcare utilization and costs of PD in newly diagnosed patients managed by movement disorder specialists. METHODS Using a longitudinal matched-cohort study of linked data from the National Neuroscience Institute Parkinson's disease and Movement Disorder and healthcare administrative databases in Singapore from 2008-2017, we compared healthcare utilization and costs between patients and controls matched on age, sex, race, and Charlson Comorbidity Index score. RESULTS 1,162 patients met study inclusion criteria and 1,157 matched controls were identified. The total mean annual healthcare cost (at 2017 costs) was significantly increased in patients compared to controls from years 1-9 post-diagnosis. The increased cost was observed 2 years before diagnosis (USD2322 vs. 2052; p < 0.001). Mean annual cost attributable to PD increased from USD1854 at 1-year post-diagnosis to USD2652 at 9 years. Over 9 years, average costs were significantly higher across all domains of healthcare utilization except primary care-cost of intermediate and long-term care was increased by a factor of 2.5, specialist care by 2.3, emergency department visits by 1.6, and hospital admissions by 1.3. CONCLUSION PD results in higher healthcare utilization and costs. Pre-diagnosis increase in healthcare utilization observed in patients supports the presence of prodromal PD symptoms and may present an opportunity for early diagnosis.
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Affiliation(s)
| | - Shermyn Neo
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Aidan Sheng Yong Wong
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Ganga Ganesan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
| | - Wei Li
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Hwee Lan Ng
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Zheyu Xu
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Kay Yaw Tay
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Wing Lok Au
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Louis Chew Seng Tan
- Duke-NUS Medical School, Singapore
- National Neuroscience Institute, Singapore
- Parkinson's Foundation Center of Excellence, Singapore
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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Terman SW, Kerr WT, Marcum ZA, Wang L, Burke JF. Antiseizure medication adherence trajectories in Medicare beneficiaries with newly treated epilepsy. Epilepsia 2021; 62:2778-2789. [PMID: 34462911 PMCID: PMC8563423 DOI: 10.1111/epi.17051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study was undertaken to characterize trajectories of antiseizure medication (ASM) adherence in adults with newly treated epilepsy and to determine predictors of trajectories. METHODS This was a retrospective cohort study using Medicare. We included beneficiaries with newly treated epilepsy (one or more ASM and none in the preceding 2 years, plus International Classification of Diseases codes) in 2010-2013. We calculated the proportion of days covered (proportion of total days with any ASM pill supply) for 8 quarters or until death. Group-based trajectory models characterized and determined predictors of trajectories. RESULTS We included 24 923 beneficiaries. Models identified four groups: early adherent (60%), early nonadherent (18%), late adherent (11%), and late nonadherent (11%). Numerous predictors were associated with being in the early nonadherent versus early adherent group: non-White race (e.g., Black, odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.5-1.8), region (e.g., South vs. Northeast: OR = 1.2, 95% CI = 1.1-1.4), and once daily initial medication (OR = 1.1, 95% CI = 1.0-1.3). Predictors associated with decreased odds of being in the early nonadherent group included older age (OR = .9 per decade, 95% CI = .9-.9), female sex (OR = .9, 95% CI = .8-1.0), full Medicaid eligibility (OR = .6, 95% CI = .4-.8), neurologist visit (OR = .6, 95% CI = .6-.7), and initial older generation ASM (OR = .6, 95% CI = .6-.7). SIGNIFICANCE We identified four ASM adherence trajectories in individuals with newly treated epilepsy. Whereas risk factors for early nonadherence such as race or geographic region are nonmodifiable, our work highlighted a modifiable risk factor for early nonadherence: lacking a neurologist. These data may guide future interventions aimed at improving ASM adherence, in terms of both timing and target populations.
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Affiliation(s)
- Samuel W. Terman
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Wesley T. Kerr
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - James F. Burke
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
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Spindler M, Jacobs D, Yuan K, Tropea T, Teng CW, Perrone C, Do D, Wechsler L. A Department Approach to Teleneurology. Telemed J E Health 2021; 27:1078-1084. [DOI: 10.1089/tmj.2020.0323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Meredith Spindler
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dina Jacobs
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy Yuan
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas Tropea
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clare W. Teng
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Perrone
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Do
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence Wechsler
- Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Yogev-Seligmann G, Kafri M. COVID-19 social distancing: negative effects on people with Parkinson disease and their associations with confidence for self-management. BMC Neurol 2021; 21:284. [PMID: 34284733 PMCID: PMC8289714 DOI: 10.1186/s12883-021-02313-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the effects of COVID-19 social distancing on the function, health, and well-being of people with Parkinson disease (PD), and test the association of these effects with patients' activation levels, i.e., their skills and confidence in managing their health. METHODS Community-dwelling individuals with PD answered an anonymous web-based survey. Part 1 included 27 multiple-choice questions regarding changes in function, health, medical care, and well-being. Part 2 consisted of the Patient Activation Measure, which enquired about skills and confidence in managing one's health. RESULTS Respondents (N = 142) reported decreases in various function (24.8%-37.3%), health (33.8%-43%), and well-being (26.1%-47.1%) domains. Rehabilitation ceased for 61.2%. Among those reporting a worsening of health, 67.8% associated this with the cessation of rehabilitative treatments or decrease in physical activity. Patients' activation levels were inversely correlated with increased assistance for activities of daily living, increased tiredness, worsening symptoms, and lack of support from family and friends. CONCLUSIONS Social distancing had a major negative impact on the health and function of people with PD. PRACTICAL IMPLICATIONS Supporting people with PD skills and confidence in managing health may preserve their physical and mental health during this period of dramatic changes in life's circumstances.
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Affiliation(s)
- Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, 3498838 Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Bensken WP, Navale SM, Andrew AS, Jobst BC, Sajatovic M, Koroukian SM. Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid. Med Care 2021; 59:588-596. [PMID: 33797505 PMCID: PMC8187271 DOI: 10.1097/mlr.0000000000001541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care. OBJECTIVE Examine markers of quality care for newly diagnosed PWE. METHODS Using Medicaid claims data (2010-2014) for 15 states we identified adults 18-64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models. RESULTS Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs. CONCLUSIONS There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Angeline S Andrew
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
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Mantese CE, Aquino ERDS, Figueira MD, Rodrigues L, Basso J, Raupp DA Rosa P. Telemedicine as support for primary care referrals to neurologists: decision-making between different specialists when guiding the case over the phone. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:299-304. [PMID: 34133510 DOI: 10.1590/0004-282x-anp-2020-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Brazil's public health system, the largest in the world, faces great challenges in establishing access to specialized care for all Brazilians. "Regula Mais Brasil" is a structuring project from the Ministry of Health that aims to optimize the referral process for specialized care throughout Brazil and uses telemedicine to support primary care physicians. The high demand for support and referrals in the neurology specialty raises questions about what the difficulties and doubts in managing these patients are and whether the training of the coordinating physician influences the orientation and outcome of referral. METHODS In a retrospective analysis on a database, all teleconsultations in the neurology specialty were evaluated. The diagnoses were categorized using the ICD-10 and according to the specialty of the coordinating teleconsultant for multiple comparisons. RESULTS In total, 1687 teleconsultations were conducted between January 10 and December 2, 2019, in the cities of Belo Horizonte and Porto Alegre and in the Federal District. The most frequent area of doubt for doctors was about epilepsy. After discussion via telemedicine, 25% of the referrals were avoided and the specialty of the teleconsultant physician did not impact the decision made: 72.3, 72.6 and 66.5%, in relation to approval by neurologists, family doctors and other experts, respectively. CONCLUSION Increasing access to specialists, not only for patients but also for doctors, helps in achieving early resolution of issues of greater difficulty for primary healthcare doctors, thus resulting in lower numbers of referrals.
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Affiliation(s)
| | | | | | | | - Josue Basso
- Hospital Sírio-Libanês, São Paulo SP, Brazil
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Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes. J Am Med Dir Assoc 2021; 22:1525-1534.e3. [PMID: 33689689 DOI: 10.1016/j.jamda.2021.01.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE After diagnosis of Alzheimer's disease and related syndromes (ADRS), personalized care adapted to each patient's needs is recommended to provide a care plan and start symptomatic treatments according to guidelines. Over the past decade, dedicated structures and care have been implemented in various settings. Equal access to ADRS care, health care providers and services is crucial to ensure potential health benefits for everyone. However, the extent of use of recommended services and favorable health care utilization trajectories (HUT) may vary according to individual and contextual characteristics. The aim of this article was to (1) describe HUT patterns after multidimensional clustering of similar trajectories, (2) assess the proportion of individuals presenting favorable HUTs, and (3) identify factors associated with favorable HUTs. DESIGN Cohort study. SETTING AND PARTICIPANTS A cohort of 103,317 people newly diagnosed with ADRS identified in the French health reimbursement system (SNDS) was followed for 5 years with their monthly utilization on 11 health care dimensions. METHODS For 3 age groups (65-74, 75-84, ≥85 years), 15 clusters of patients were identified using partitioning around medoids applied to Levenshtein distances. They were qualitatively assessed by pluridisciplinary experts. Individual and contextual determinants of clusters denoting favorable trajectories were identified using mixed random effects multivariable logistic regression models. RESULTS Clusters with favorable HUTs denoting slow, progressive trajectories centered on at-home care, represented approximatively 25% of the patients. Determinants of favorable HUTs were mostly individual (age, female gender, absence of certain comorbidities, circumstances of ADRS identification, lower deprivation). Contextual determinants were also identified, in particular accessibility to nurses and nursing homes. Inter-territories variance was small but significant in all age groups (from 0.9% to 1.8%). CONCLUSION AND IMPLICATIONS Favorable HUTs remain the minority and many efforts can still be made to improve HUTs. Qualitative studies could help understanding underlying barriers to favorable HUTs.
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Park SJ, Shin H, Won C, Min DH. Non-viral, direct neuronal reprogramming from human fibroblast using a polymer-functionalized nanodot. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 32:102316. [PMID: 33068744 DOI: 10.1016/j.nano.2020.102316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
Among various strategies to treat neurodegenerative disorders, cell replacement therapies have drawn much attention recently. Such a trend led to the increase in demand for the rare and specialized cells, followed by the outburst development of various cell reprogramming strategies. However, several limitations on these conventional methods remain to be solved, including the genetic instability of the viral vectors and the high cytotoxicity or poor performance of the non-viral carriers. Therefore, non-viral methods need to be developed to ensure safe and efficient cell reprogramming. Here, we introduce a polymer-modified nano-reagent (Polymer-functionalized Nanodot, PolyN) for the safe and efficient, non-viral direct cell reprogramming. PolyN facilitated the highly efficient contemporary overexpression of the transgene compared to the conventional reagent. With our nano-reagent, we demonstrated the SOX2-mediated cell reprogramming and successfully generated the neuron-like cell from the human fibroblast.
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Affiliation(s)
- Se-Jin Park
- Department of Chemistry, Seoul National University, Seoul, Republic of Korea
| | - Hojeong Shin
- Department of Chemistry, Seoul National University, Seoul, Republic of Korea
| | - Cheolhee Won
- Institute of Biotherapeutics Convergence Technology, Lemonex Inc., Seoul, Republic of Korea
| | - Dal-Hee Min
- Department of Chemistry, Seoul National University, Seoul, Republic of Korea; Department of Biological Sciences, Seoul National University, Seoul, Republic of Korea; Institute of Biotherapeutics Convergence Technology, Lemonex Inc., Seoul, Republic of Korea.
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15
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Dahodwala N, Li P, Jahnke J, Ladage VP, Pettit AR, Kandukuri PL, Bao Y, Zamudio J, Jalundhwala YJ, Doshi JA. Burden of Parkinson's Disease by Severity: Health Care Costs in the U.S. Medicare Population. Mov Disord 2020; 36:133-142. [PMID: 33031604 DOI: 10.1002/mds.28265] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current understanding of the health care costs of Parkinson's disease (PD) and the incremental burden of advanced disease is incomplete. OBJECTIVES The aim of this study was to assess the direct economic burden associated with advanced versus mild/moderate PD in a prevalent national sample of elderly U.S. Medicare beneficiaries with a PD diagnosis. METHODS Analyzing 100% fee-for-service Medicare claims from 2013, we defined advanced PD with a medication-based algorithm and calculated all-cause and PD-related costs for the overall sample and by disease severity. We measured primary PD-related costs (based on claims with a primary diagnosis of PD) and any PD-related costs (based on claims with PD in any diagnostic field). Generalized linear models were used to estimate risk-adjusted mean cost differences between the advanced and mild/moderate PD groups for the calendar year. RESULTS The final sample (N = 144,703) had mean observed all-cause, primary PD-related, and any PD-related costs of $23,041 (SD, $34,045), $3429 (SD, $7431), and $9924 (SD, $22,140), respectively. Twenty percent of patients were classified as advanced PD. Costs varied substantially; any PD-related mean costs were $483 for the lowest patient decile (which included 1% of the advanced group) and $48,145 for the highest decile (which included 15% of the advanced group). Incremental risk-adjusted costs of advanced PD were $5818 (95% confidence interval [CI]: $5411-$6225) for all-cause costs, $3644 (95% CI: $3484-$3806) for primary PD-related costs, and $6088 (95% CI: $5779-$6398) for any PD-related costs. CONCLUSIONS Elderly Medicare beneficiaries with PD had substantial variation in PD-related costs. Advanced PD was associated with a larger economic burden than mild/moderate PD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pengxiang Li
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jordan Jahnke
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vrushabh P Ladage
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy R Pettit
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Yanjun Bao
- AbbVie Inc., North Chicago, Illinois, USA
| | | | | | - Jalpa A Doshi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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A multidisciplinary care model to increase access to neurologic ambulatory care. J Am Assoc Nurse Pract 2020; 33:254-259. [PMID: 33690259 DOI: 10.1097/jxx.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expert patient care has been associated with improved outcomes for neurology patients, yet timely access to specialists is challenging. The employment of nurse practitioners (NPs) holds great potential to increase access to neurologic ambulatory care, however little practical guidance exists to date for how this may be achieved. LOCAL PROBLEM To improve timely care provision for patients with neurologic disease, we employed a multidisciplinary care utilization framework that used NPs to expand clinic appointment availability. METHODS AND INTERVENTION After evaluating our baseline performance, we applied a standardized approach to the deployment of NPs in neurology clinic with regard to scheduling clinic sessions and patient appointments. The primary outcome measure was appointment availability measured over 6 months preintervention (June to November 2016) and 6 months postintervention (June to November 2017). Secondary measures included NP effort allocation. RESULTS The postintervention period demonstrated an increase in available appointments (3,731 preintervention vs. 4,318 postintervention) and scheduled appointments (2,014 vs. 2,685). Nurse practitioners spent more time practicing at the fullest extent of their licensure. All improvements were accomplished without the hiring of additional staff. CONCLUSIONS A multidisciplinary care utilization framework for NP employment across neurology subspecialties resulted in an increase in appointment availability. Furthermore, this model is likely to be sustainable due to provider satisfaction and financial viability.
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Ney JP, Satya-Murti S. Can and should neurologists screen their patients for depression? Yes, and…. Neurol Clin Pract 2020; 10:186-187. [PMID: 32644056 PMCID: PMC7292567 DOI: 10.1212/cpj.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John P Ney
- Boston University School of Medicine (JPN); VA Center for Healthcare Organization and Implementation Research, Bedford, MA; and Health Policy Consultant (SS-M), Santa Maria, CA
| | - Saty Satya-Murti
- Boston University School of Medicine (JPN); VA Center for Healthcare Organization and Implementation Research, Bedford, MA; and Health Policy Consultant (SS-M), Santa Maria, CA
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18
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Hill CE, Lin CC, Burke JF, Kerber KA, Skolarus LE, Esper GJ, Magliocco B, Callaghan BC. Claims data analyses unable to properly characterize the value of neurologists in epilepsy care. Neurology 2019; 92:e973-e987. [PMID: 30674587 DOI: 10.1212/wnl.0000000000007004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/25/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To determine the association of a neurologist visit with health care use and cost outcomes for patients with incident epilepsy. METHODS Using health care claims data for individuals insured by United Healthcare from 2001 to 2016, we identified patients with incident epilepsy. The population was defined by an epilepsy/convulsion diagnosis code (ICD codes 345.xx/780.3x, G40.xx/R56.xx), an antiepileptic prescription filled within the succeeding 2 years, and neither criterion met in the 2 preceding years. Cases were defined as patients who had a neurologist encounter for epilepsy within 1 year after an incident diagnosis; a control cohort was constructed with propensity score matching. Primary outcomes were emergency room (ER) visits and hospitalizations for epilepsy. Secondary outcomes included measures of cost (epilepsy related, not epilepsy related, and antiepileptic drugs) and care escalation (including EEG evaluation and epilepsy surgery). RESULTS After participant identification and propensity score matching, there were 3,400 cases and 3,400 controls. Epilepsy-related ER visits were more likely for cases than controls (year 1: 5.9% vs 2.3%, p < 0.001), as were hospitalizations (year 1: 2.1% vs 0.7%, p < 0.001). Total medical costs for epilepsy care, nonepilepsy care, and antiepileptic drugs were greater for cases (p ≤ 0.001). EEG evaluation and epilepsy surgery occurred more commonly for cases (p ≤ 0.001). CONCLUSIONS Patients with epilepsy who visited a neurologist had greater subsequent health care use, medical costs, and care escalation than controls. This comparison using administrative claims is plausibly confounded by case disease severity, as suggested by higher nonepilepsy care costs. Linking patient-centered outcomes to claims data may provide the clinical resolution to assess care value within a heterogeneous population.
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Affiliation(s)
- Chloe E Hill
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN.
| | - Chun Chieh Lin
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - James F Burke
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - Kevin A Kerber
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - Lesli E Skolarus
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - Gregory J Esper
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - Brandon Magliocco
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
| | - Brian C Callaghan
- From the Health Services Research Program (C.E.H., C.C.L., J.F.B., K.A.K., L.E.S., B.C.C.), Department of Neurology, University of Michigan, Ann Arbor; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and American Academy of Neurology (B.M.), Minneapolis, MN
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19
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Owens S, Sirven JI, Shafer PO, Fishman J, Wild I, Findley M, Derry R, Walters J, Kopplin V, Kakacek J. Innovative approaches reaching underserved and rural communities to improve epilepsy care: A review of the methodology of the Connectors Project. Epilepsy Behav 2019; 90:273-283. [PMID: 30391149 DOI: 10.1016/j.yebeh.2018.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The Connectors Project, a collaboration between the Epilepsy Foundation and UCB Pharma, was a multiyear project designed to improve epilepsy care in underserved communities. A core objective of the Connectors Project was to pilot new and innovative approaches to epilepsy awareness and education in rural and underserved areas, including standardized curricula for healthcare providers and patients. METHODS A series of consensus conferences explored opportunities and barriers to epilepsy care throughout the United States including access to local Epilepsy Foundations, neurologists, and epilepsy centers. Data from QuintilesIMS™ were examined for access to newer antiepileptic drugs (AEDs)-a proxy for quality of epilepsy care-in different regions. State factors (e.g., local epilepsy foundation office, access to newer vs. older AEDs, and geographic density and diversity) were used in selecting four states as examples of rural and underserved areas to pilot the awareness and educational programs. For each state, a work team assessed challenges and opportunities, tailored educational curricula, and developed strategies for effective delivery of the educational programs. Interventions were held between June 2016 and June 2017. Interventions consisted of outreach and awareness programs, in-person health education to healthcare providers and patients/families, and digital health education. RESULTS Michigan, Nevada, Oklahoma, and West Virginia were identified as pilot states representing geographically diverse areas, ranging from a state with a large high-density population center with several epilepsy centers and a local Epilepsy Foundation office (Michigan) to a state with predominately rural areas and a few small urban cores, two epilepsy centers, and no in-state Epilepsy Foundation office (West Virginia). State work teams tailored interventions and examined options for type, intent, ease of use, and impact. All states implemented outreach and awareness initiatives and in-person health education for patients and healthcare providers; use of digital health education was variable. Measurement of the interventions was agreed to be performed by the use of patient and physician surveys and reevaluation of data from QuintilesIMS for access to newer AEDs. CONCLUSION Local Epilepsy Foundation offices successfully connected healthcare providers in rural and underserved areas to epilepsy education designed to enhance quality care in epilepsy. Educational opportunities for people with epilepsy and their families addressed critical gaps in accessing quality epilepsy care and self-management. Tailored and innovative educational approaches can be used to increase awareness levels and to overcome geographic challenges in reaching underserved populations. Relationship building and repeated, consistent engagement with healthcare providers and patients can assist in improving communication and self-management skills among patients with epilepsy.
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Affiliation(s)
- Steven Owens
- Epilepsy Foundation, 8301 Professional Place-East, Suite 200, Landover, MD 20785, USA.
| | - Joseph I Sirven
- Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Patricia O Shafer
- Epilepsy Foundation, 8301 Professional Place-East, Suite 200, Landover, MD 20785, USA; Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Jesse Fishman
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
| | - Imane Wild
- UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA.
| | - Mark Findley
- Epilepsy Foundation of Greater Cincinnati, 895 Central Avenue, Suite 550, Cincinnati, OH 45202, USA.
| | - Russell Derry
- Epilepsy Foundation of Michigan, 25200 Telegraph Road, Suite 110, Southfield, MI 48033, USA.
| | - Jenniafer Walters
- Epilepsy Foundation of Oklahoma, 11212 North May Avenue Suite 108, Oklahoma City, OK 73120, USA.
| | - Vicki Kopplin
- Epilepsy Foundation of Minnesota, 8301 Professional Place East, Suite 200, St. Paul, MN 20785, USA.
| | - Jody Kakacek
- Epilepsy Foundation, 8301 Professional Place-East, Suite 200, Landover, MD 20785, USA.
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20
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Sandrone S, Berthaud JV, Chuquilin M, Cios J, Ghosh P, Gottlieb-Smith RJ, Kushlaf H, Mantri S, Masangkay N, Menkes DL, Nevel KS, Sarva H, Schneider LD. Neurologic and neuroscience education. Neurology 2018; 92:174-179. [DOI: 10.1212/wnl.0000000000006716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/21/2018] [Indexed: 01/06/2023] Open
Abstract
Neurologic disorders are among the most frequent causes of morbidity and mortality in the United States. Moreover, the current shortfall of neurologists is expected to worsen over the coming decade. As a consequence, many patients with neurologic disorders will be treated by physicians and primary care providers without formal neurologic training. Furthermore, a pervasive and well-described fear of neurology, termed neurophobia, has been identified in medical student cohorts, residents, and among general practitioners. In this article, members of the American Academy of Neurology A.B. Baker Section on Neurological Education review current guidelines regarding neurologic and neuroscience education, contextualize the genesis and the negative consequences of neurophobia, and provide strategies to mitigate it for purposes of mentoring future generations of health care providers.
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21
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Oberfrank F, Ajtay A, Bereczki D. Demand for neurological services in Central Eastern Europe: a 10-year national survey in Hungary. Eur J Neurol 2018; 25:984-990. [PMID: 29603492 DOI: 10.1111/ene.13645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE In order to plan neurological capacities at a national level for the next decade, the current use of neurological services should be evaluated. We analyzed the utilization of neurological services in Hungary, a country with a single-payer health insurance system covering the whole population. METHODS We created a database from medical reports submitted to the National Health Insurance Fund from all hospitals and outpatient services between 2004 and 2013. The number of subjects presenting to the neurological healthcare system and their major diagnoses by 10th International Classification of Diseases categories were analyzed. The overall healthcare service utilization of these patients was also estimated. RESULTS Of the 10 million inhabitants, 2.9 million people used an inpatient or outpatient neurological service at least once over the 10-year period. Annually, 1% of the population was admitted to neurological inpatient wards and 6% of the population used some neurological outpatient service. Major reasons for using neurological services were: cerebrovascular diseases (I60-I69; 1.2 million patients), episodic and paroxysmal disorders (G40-G47; 1.3 million patients) and general symptoms and signs (R50-R56; 1.3 million patients). The 2.9 million people had 12.7 million hospital admissions to any ward and 365.7 million outpatient visits to any specialist during the 10 years. CONCLUSIONS The demand for neurological services is high in Hungary; close to 30% of the population used an inpatient or outpatient neurological service at least once during this 10-year period. Results from this project provide data for international comparisons and help to ensure better informed and more focused resource allocation.
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Affiliation(s)
- F Oberfrank
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest
| | - A Ajtay
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - D Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Mantyh WG, Cohen BH, Ciccarelli L, Philpot LM, Jones LK. Expanding incentives for coordinated, patient-centered care: Implications for neurologists. Neurol Clin Pract 2018. [PMID: 29517056 DOI: 10.1212/cpj.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes. CMS has also included language indicating that nonphysician providers (i.e., nurse practitioners and physician assistants) can perform many of these services independently. The 2017 and now the 2018 fee schedules thus create new payments for non-face-to-face, patient-centered services, and may allow neurologists to reach out to more patients through nonphysician providers. As health care in the United States moves toward value-based incentives, these newly supported non-face-to-face services will provide neurologists with new tools to deliver sustainable, high-value care.
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Affiliation(s)
- William G Mantyh
- Department of Neurology (WGM, LKJ) and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP), Mayo Clinic, Rochester, MN; Rebecca D. Considine Research Institute and The NeuroDevelopmental Science Center (BHC), Department of Pediatrics, Akron's Children's Hospital, OH; and Center for Health Policy (LC), American Academy of Neurology, Minneapolis, MN
| | - Bruce H Cohen
- Department of Neurology (WGM, LKJ) and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP), Mayo Clinic, Rochester, MN; Rebecca D. Considine Research Institute and The NeuroDevelopmental Science Center (BHC), Department of Pediatrics, Akron's Children's Hospital, OH; and Center for Health Policy (LC), American Academy of Neurology, Minneapolis, MN
| | - Luana Ciccarelli
- Department of Neurology (WGM, LKJ) and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP), Mayo Clinic, Rochester, MN; Rebecca D. Considine Research Institute and The NeuroDevelopmental Science Center (BHC), Department of Pediatrics, Akron's Children's Hospital, OH; and Center for Health Policy (LC), American Academy of Neurology, Minneapolis, MN
| | - Lindsey M Philpot
- Department of Neurology (WGM, LKJ) and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP), Mayo Clinic, Rochester, MN; Rebecca D. Considine Research Institute and The NeuroDevelopmental Science Center (BHC), Department of Pediatrics, Akron's Children's Hospital, OH; and Center for Health Policy (LC), American Academy of Neurology, Minneapolis, MN
| | - Lyell K Jones
- Department of Neurology (WGM, LKJ) and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (LMP), Mayo Clinic, Rochester, MN; Rebecca D. Considine Research Institute and The NeuroDevelopmental Science Center (BHC), Department of Pediatrics, Akron's Children's Hospital, OH; and Center for Health Policy (LC), American Academy of Neurology, Minneapolis, MN
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23
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Ney JP, Sico JJ, Klein BC, Magliocco B, Callaghan BC, Esper GJ. Association of neurologist care with headache expenditures: A population-based, longitudinal analysis. Cephalalgia 2018; 38:1876-1884. [PMID: 29504480 DOI: 10.1177/0333102418762572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess the association of neurologist ambulatory care with healthcare utilization and expenditure in headache. Methods This was a longitudinal cohort study from two-year duration panel data, pooled from 2002-2013, of adult respondents identified with diagnostic codes for headache in the Medical Expenditure Panel Survey. Those with a neurologist ambulatory care visit in year one of panel participation were compared with those who did not for the change in annual aggregate direct headache-related health care costs from year one to year two of panel participation, inflated to 2015 US dollars. Results were adjusted via multiple linear regression for demographic and clinical variables, utilizing survey variables for accurate estimates and standard errors. Results Eight hundred and eighty-seven respondents were included, with 23.3% (207/887) seeing a neurologist in year one. The neurologist group had higher year-one mean headache-related expenditures ($3032 vs. $1636), but nearly equal mean year-two expenditures compared to controls ($1900 vs. $1929). Adjusted association between neurologist care and difference in mean annual expenditures from year two to year one was -$1579 (95% CI -$2468, -$690, p < 0.001). Conclusion Among headache sufferers, particularly those with higher headache-related healthcare expenditures, neurologist care is associated with a significant reduction in costs over two years.
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Affiliation(s)
- John P Ney
- 1 Boston University School of Medicine, Boston, MA, USA.,2 University of Washington, Seattle, WA, USA
| | - Jason J Sico
- 3 Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Brad C Klein
- 4 Abington Hospital-Jefferson Health, Abington Neurological Associates, Abington, PA, USA
| | | | - Brian C Callaghan
- 6 Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Han L, Maciejewski M, Brockel C, Afzelius L, Altman RB. Mendelian Disease Associations Reveal Novel Insights into Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:471-481. [PMID: 29462399 PMCID: PMC6037048 DOI: 10.1093/ibd/izx087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 12/14/2022]
Abstract
Background Monogenic diseases have been shown to contribute to complex disease risk and may hold new insights into the underlying biological mechanism of Inflammatory Bowel Disease (IBD). Methods We analyzed Mendelian disease associations with IBD using over 55 million patients from the Optum's deidentified electronic health records dataset database. Using the significant Mendelian diseases, we performed pathway enrichment analysis and constructed a model using gene expression datasets to differentiate Crohn's disease (CD), ulcerative colitis (UC), and healthy patient samples. Results We found 50 Mendelian diseases were significantly associated with IBD, with 40 being significantly associated with both CD and UC. Our results for CD replicated those from previous studies. Pathways that were enriched consisted of mainly immune and metabolic processes with a focus on tolerance and oxidative stress. Our 3-way classifier for UC, CD, and healthy samples yielded an accuracy of 72%. Conclusions Mendelian diseases that are significantly associated with IBD may reveal novel insights into the genetic architecture of IBD.
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Affiliation(s)
- Lichy Han
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
| | | | | | | | - Russ B Altman
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
- Department of Genetics, Stanford University, Stanford, CA
- Department of Bioengineering, Stanford University, Stanford, CA
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Young NP, Elrashidi MY, McKie PM, Ebbert JO. Neuroimaging utilization and findings in headache outpatients: Significance of red and yellow flags. Cephalalgia 2018; 38:1841-1848. [DOI: 10.1177/0333102418758282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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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Affiliation(s)
- Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Muhamad Y Elrashidi
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul M McKie
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Callaghan BC, Burke JF, Kerber KA, Skolarus LE, Ney JP, Magliocco B, Esper GJ. The association of neurologists with headache health care utilization and costs. Neurology 2018; 90:e525-e533. [PMID: 29321226 DOI: 10.1212/wnl.0000000000004925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/27/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the association of a neurologist visit with headache health care utilization and costs. METHODS Utilizing a large privately insured health care claims database, we identified patients with an incident headache diagnosis (ICD-9 codes 339.xx, 784.0x, 306.81) with at least 5 years follow-up. Patients with a subsequent neurologist visit were matched to controls without a neurologist visit using propensity score matching, accounting for 54 potential confounders and regional variation in neurologist density. Co-primary outcomes were emergency department (ED) visits and hospitalizations for headache. Secondary outcomes were quality measures (abortive, prophylactic, and opioid prescriptions) and costs (total, headache-related, and non-headache-related). Generalized estimating equations assessed differences in longitudinal outcomes between cases and controls. RESULTS We identified 28,585 cases and 57,170 controls. ED visits did not differ between cases and controls (p = 0.05). Hospitalizations were more common in cases in year 0-1 (0.2%, 95% confidence interval [CI] 0.2%-0.3% vs 0.01%, 95% CI 0.01%-0.02%; p < 0.01), with minimal differences in subsequent years. Costs (including non-headache-related costs) and high-quality and low-quality medication utilization were higher in cases in the first year and decreased toward control costs in subsequent years with small differences persisting over 5 years. Opioid prescriptions increased over time in both cases and controls. CONCLUSION Compared with those without a neurologist, headache patients who visit neurologists had a transient increase in hospitalizations, but the same ED utilization. Confounding by severity is the most likely explanation given the non-headache-related cost trajectory. Claims-based risk adjustment will likely underestimate disease severity of headache patients seen by neurologists.
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Affiliation(s)
- Brian C Callaghan
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta.
| | - James F Burke
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
| | - Kevin A Kerber
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
| | - Lesli E Skolarus
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
| | - John P Ney
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
| | - Brandon Magliocco
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
| | - Gregory J Esper
- From the Health Services Research Program, Department of Neurology (B.C.C., J.F.B., K.A.K., L.E.S.), University of Michigan; Veterans Affairs Healthcare System (B.C.C., J.F.B.), Ann Arbor, MI; Boston University School of Medicine (J.P.N.), MA; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta
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Goldenberg JN, Torgovnick J, Berger JR. The financial contribution of the multiple sclerosis specialistAuthor Responds:. Neurol Clin Pract 2017; 7:378-379. [DOI: 10.1212/cpj.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Saadi A, Himmelstein DU, Woolhandler S, Mejia NI. Racial disparities in neurologic health care access and utilization in the United States. Neurology 2017; 88:2268-2275. [PMID: 28515272 DOI: 10.1212/wnl.0000000000004025] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/22/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States. METHODS We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy). To assess disparities in neurologic care utilization, we performed logistic regression analyses of outpatient department neurologic care visit rates and expenditures for each racial ethnic group controlling for age, sex, health status, socioeconomic characteristics, and geographic region of care. RESULTS Of the 279,103 MEPS respondents, 16,936 (6%) self-reported a neurologic condition; 5,890 (2%) received a total of 13,685 outpatient neurology visits. Black participants were nearly 30% less likely to see an outpatient neurologist (odds ratio [OR] 0.72, confidence interval [CI] 0.64-0.81) relative to their white counterparts, even after adjustment for demographic, insurance, and health status differences. Hispanic participants were 40% less likely to see an outpatient neurologist (OR 0.61, CI 0.54-0.69). Among participants with known neurologic conditions, blacks were more likely to be cared for in the emergency department, to have more hospital stays, and to have higher per capita inpatient expenditures than their white counterparts. CONCLUSIONS Our findings highlight racial and ethnic inequalities in the utilization of neurologic care in the United States.
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Affiliation(s)
- Altaf Saadi
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston.
| | - David U Himmelstein
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
| | - Steffie Woolhandler
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
| | - Nicte I Mejia
- From Partners Neurology Residency Program (A.S.), Massachusetts General Hospital and Brigham and Woman's Hospital; Harvard Medical School (A.S., D.U.H., S.W., N.I.M.), Boston, MA; City University of New York at Hunter College (D.U.H., S.W.), New York; and Massachusetts General Hospital (N.I.M.), Boston
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Wilkinson DA, Johnson K, Garton HJL, Muraszko KM, Maher CO. Trends in surgical treatment of Chiari malformation Type I in the United States. J Neurosurg Pediatr 2017; 19:208-216. [PMID: 27834622 DOI: 10.3171/2016.8.peds16273] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network. METHODS The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures. RESULTS There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division. CONCLUSIONS Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.
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Affiliation(s)
| | - Kyle Johnson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Hugh J L Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Hill CE, Thomas B, Sansalone K, Davis KA, Shea JA, Litt B, Dahodwala N. Improved availability and quality of care with epilepsy nurse practitioners. Neurol Clin Pract 2017; 7:109-117. [PMID: 28409062 DOI: 10.1212/cpj.0000000000000337] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/02/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study investigated the quality of care delivered by nurse practitioner (NP)-physician teams employed to expand clinic appointment availability for patients with epilepsy. METHODS We performed a retrospective observational cohort study of patients with epilepsy presenting to the Penn Epilepsy Center for a new patient appointment in 2014. During this time, patients were seen either by an NP-physician team care model or a more traditional physician-only care model. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures at the initial visit. Clinical outcomes of seizure frequency, presentations to the Emergency Department, injury, and death were assessed over the subsequent year. RESULTS A total of 169 patients were identified by our inclusion and exclusion criteria: 65 patients in the NP-physician team care model cohort and 104 patients in the physician-only care model cohort. The NP-physician team care model saw, on average, 3 more patients per clinic session. There were no meaningful differences between these cohorts in baseline characteristics. The NP-physician team care model showed equivalent adherence to the physician-only care model for the epilepsy quality measures, with superior adherence to the counseling measures of querying for side effects, provision of personalized epilepsy safety education, and screening for behavioral health disorders. The 2 care models performed similarly in all clinical outcomes. CONCLUSIONS An NP-physician team care model employed to increase availability of care could also improve quality of care delivered.
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Affiliation(s)
- Chloe E Hill
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Bethany Thomas
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Kimberly Sansalone
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Kathryn A Davis
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Judy A Shea
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Brian Litt
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
| | - Nabila Dahodwala
- Departments of Neurology (CEH, BT, KS, KAD, BL, ND) and Medicine (JAS), University of Pennsylvania, Philadelphia
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Lukas RV, Blood AD, Brorson JR, Albert DVF. Ambulatory training in neurology education. J Neurol Sci 2017; 372:506-509. [PMID: 27838003 DOI: 10.1016/j.jns.2016.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/30/2016] [Accepted: 11/04/2016] [Indexed: 12/29/2022]
Abstract
Much of the care provided by practicing neurologists takes place in outpatient clinics. However, neurology trainees often have limited exposure to this setting. Adequate incorporation of outpatient care in neurology training is vital; however it is often hampered by numerous challenges. We detail a number of these challenges and suggest potential means for improvement.
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Affiliation(s)
- Rimas V Lukas
- University of Chicago, Department of Neurology, United States.
| | | | - James R Brorson
- University of Chicago, Department of Neurology, United States
| | - Dara V F Albert
- Ohio State University, Nationwide Children's Hospital, Department of Pediatrics, Section of Pediatric Neurology, United States
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Affiliation(s)
- Neil A Busis
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; and Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle.
| | - Gary M Franklin
- From the Department of Neurology (N.A.B.), University of Pittsburgh School of Medicine, PA; and Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services (G.M.F.), University of Washington, Seattle
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Sigsbee B, Goldenberg JN, Bever CT, Schierman B, Jones LK. Introducing the Axon Registry: An opportunity to improve quality of neurologic care. Neurology 2016; 87:2254-2258. [PMID: 27694258 DOI: 10.1212/wnl.0000000000003264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022] Open
Abstract
Clinical quality data registries are increasingly popular tools used by providers to improve the quality of clinical care and satisfy growing numbers of regulatory and reporting requirements. Specialty societies use registries to provide value to their members and guide improvements in care at the population level. In this article, we outline the rationale, structure, function, and challenges related to the American Academy of Neurology's development of its own clinical quality data registry: the Axon Registry.
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Affiliation(s)
- Bruce Sigsbee
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN.
| | - James N Goldenberg
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Christopher T Bever
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Becky Schierman
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
| | - Lyell K Jones
- From Penobscot Bay Medical Center (B.S.), Rockport, ME; Medical Specialists of the Palm Beaches (J.N.G.), Palm Beach, FL; University of Maryland School of Medicine (C.T.B.), Baltimore; American Academy of Neurology (B.S.), Minneapolis; and Mayo Clinic (L.K.J.), Rochester, MN
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Kister I, Corboy JR. Reducing costs while enhancing quality of care in MS. Neurology 2016; 87:1617-1622. [PMID: 27590294 DOI: 10.1212/wnl.0000000000003113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Abstract
The rapid escalation in prices of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the past decade has resulted in a dramatic overall increase in the costs of MS-related care. In this article, we outline various approaches whereby neurologists can contribute to responsible cost containment while maintaining, and even enhancing, the quality of MS care. The premise of the article is that clinicians are uniquely positioned to introduce innovative management strategies that are both medically sound and cost-efficient. We describe our "top 5" recommendations, including strategies for customizing relapse treatment; developing alternative dosing schedules for Food and Drug Administration-approved MS DMTs; using off-label therapies for relapse suppression; and limiting the use of DMTs to those who clearly fulfill diagnostic criteria, and who might benefit from continued use over time. These suggestions are well-grounded in the literature and our personal experience, but are not always supported with rigorous Class I evidence as yet. We advocate for neurologists to take a greater role in shaping clinical research agendas and helping to establish cost-effective approaches on a firm empiric basis.
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Affiliation(s)
- Ilya Kister
- From the Department of Neurology (I.K.), NYU Multiple Sclerosis Care Center, NYU School of Medicine, New York, NY; Department of Neurology (J.R.C.), University of Colorado School of Medicine; and Rocky Mountain MS Center at University of Colorado (J.R.C.), Aurora.
| | - John R Corboy
- From the Department of Neurology (I.K.), NYU Multiple Sclerosis Care Center, NYU School of Medicine, New York, NY; Department of Neurology (J.R.C.), University of Colorado School of Medicine; and Rocky Mountain MS Center at University of Colorado (J.R.C.), Aurora
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Brownlee WJ, Ciccarelli O. All relapsing multiple sclerosis patients should be managed at a specialist clinic - YES. Mult Scler 2016; 22:873-5. [PMID: 27207459 DOI: 10.1177/1352458516636474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wallace J Brownlee
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Affiliation(s)
- Lyell K Jones
- From the Mayo Clinic (L.K.J.), Rochester, MN; and UCLA Medical Center (M.R.N.), Los Angeles, CA.
| | - Marc R Nuwer
- From the Mayo Clinic (L.K.J.), Rochester, MN; and UCLA Medical Center (M.R.N.), Los Angeles, CA
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