Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 407 East 61 St, New York, NY, 10065, USA.
Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, USA.
Neurocrit Care. 2019 Feb;30(1):177-184. doi: 10.1007/s12028-018-0598-5.
We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease.
Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI).
Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5-28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5-3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3-26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2-43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients' county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1-8.1).
Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries.
我们旨在描述为神经/神经外科疾病提供重症监护的美国医生的专业分类。
我们使用了来自全国代表性的 5%的 Medicare 受益人的住院患者索赔数据，选择了有发生危及生命的表现、需要重症监护的神经/神经外科疾病住院患者。我们使用了当前程序术语代码确定了提交重症监护索赔的提供者的医疗专业，并且使用了国家提供者标识符号码，合并了来自美国神经科专业委员会 (UCNS) 的数据，以确定提供者是否为神经重症监护的 UCNS 理事会会员。我们将具有临床神经科学背景的提供者定义为神经病学家、神经外科医生和/或神经重症监护的 UCNS 理事会会员。我们将神经重症监护服务定义为在具有相关主要医院出院诊断且≥3 次总重症监护索赔的患者中，有资格进行神经重症监护的索赔，不包括住院第一天的索赔，因为这些索赔主要是急诊索赔。我们使用描述性统计和确切置信区间 (CI) 报告了我们的发现。
在 1952305 名 Medicare 受益人中，我们确定了 99937 例至少有一次神经重症监护索赔的住院患者。在我们的主要分析中，神经病学家占索赔的 28.0%（95%CI，27.5-28.5%），神经外科医生占 3.7%（95%CI，3.5-3.9%），UCNS 认证的神经重症监护医生占 25.8%（95%CI，25.3-26.3%），具有任何临床神经科学背景的提供者占 42.8%（95%CI，42.2-43.3%）。具有临床神经科学背景的医生管理的可能性与患者所在县的社会经济地位成正比，与我们样本中其他开具重症监护账单的医生相比，这些医生在学术医疗中心工作的可能性高 3 倍（优势比，2.9；95%CI，1.1-8.1）。
在美国 Medicare 受益人中，具有专门临床神经科学背景的医生仅占神经重症监护服务的不到一半。
