Ney John P, Johnson Barbara, Knabel Tom, Craft Karolina, Kaufman Joel
From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
Neurology. 2016 Jan 26;86(4):367-74. doi: 10.1212/WNL.0000000000002276. Epub 2015 Dec 23.
To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization.
The Optum proprietary claims dataset (2010-2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third--party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.
For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD).
Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization.
在一个详细记录成本、不良事件和医疗保健利用情况的大型行政索赔数据集中，确定神经科医生门诊护理在慢性神经疾病中的价值。
研究了Optum专有索赔数据集（2010 - 2012年），以描述直接医疗保健成本，以及大量慢性神经疾病患者的特定结果指标。在研究的第一阶段，我们详细说明了神经科医生的参与情况以及10种神经疾病在发作治疗组（ETG）内年度化允许第三方支付的差异。在第二阶段，我们研究了癫痫、帕金森病（PD）、中风和多发性硬化症（MS）的ETG在有和没有神经科医生参与情况下的医疗保健利用情况。报告的结果是治疗组之间未经调整的差异和比值比。
在第一阶段，共识别出10种神经疾病的1,913,605个ETG，其中30.1%符合神经科医生参与的标准。当神经科医生参与护理时，所有疾病的直接成本都更高，从阿尔茨海默病痴呆症增加25%到MS护理增加100%不等。在第二阶段，有神经科医生门诊护理时骨折、感染、急诊护理和住院入院情况较少，而神经科医生护理与更多地使用特定疾病治疗相关（MS中的免疫疗法、房颤相关性中风中的抗凝治疗、PD中的深部脑刺激和多巴胺能疗法）。
神经科医生参与护理与更高的未经调整的允许支付相关，但不良事件较少，急性护理利用也较少。
