Kurek Alexis, Boone-Sautter Kennedy, Hingtgen Cynthia M, Ahmed Aiesha
Population Health (AK, KB-S), Corewell Health West; and Neurological Health (CMH, AA), Corewell Health West Grand Rapids, MI.
Neurol Clin Pract. 2024 Jun;14(3):e200274. doi: 10.1212/CPJ.0000000000200274. Epub 2024 Apr 5.
Demand for specialty neurologic care has been steadily increasing over the past several decades, and health systems are needing to meet the demands of their patients while managing a dwindling workforce. This retrospective study investigates the operational impact of a regional neurology clinic staffed by advanced practice providers with remote physician oversight in a "hub and spoke" delivery model to serve lower complexity patients.
A retrospective, cross-sectional study was conducted to evaluate outcomes. Descriptive analysis of referral volumes, cancellation/no-show rates, and patient complexity as determined by the reason for referral were used to evaluate patients who received referrals from rural counties north of the primary neurology practice before and after the opening of the regional clinic. These metrics were evaluated longitudinally from counties of interest and for differences in patients seen at the regional clinic vs primary neurology practice.
Referral volumes from the northern counties increased at significantly higher rates after the opening of the regional clinic than other counties in the serviced area. This resulted in an increase in patients seen in the hub clinics and spoke clinic. The regional clinic did see patients who were less complex than the primary practice; however, the total volume of low-complexity patients scheduled at the primary practice did not decrease. Cancellation and no-show rates did not seem to be affected in either clinic.
The opening of a regional "spoke" clinic resulted in the generation of greater referral volumes that exceeded the capacity created by the clinic. Owing to this, there was an increase in the number of patients seen from the regional counties in the hub clinics, negating the potential benefit of improving access for high-complexity patients. Importance of demand-shaping and appropriate utilization as part of the value equation are discussed, followed by discussion of mitigation strategies.
在过去几十年中，对专科神经科护理的需求一直在稳步增长，医疗系统需要在管理不断减少的劳动力的同时满足患者的需求。这项回顾性研究调查了在“中心-辐条”服务模式下，由高级执业提供者配备远程医生监督的区域神经科诊所对服务低复杂性患者的运营影响。
进行了一项回顾性横断面研究以评估结果。对转诊量、取消/未到诊率以及根据转诊原因确定的患者复杂性进行描述性分析，以评估在区域诊所开业前后从主要神经科诊所北部农村县接受转诊的患者。这些指标从感兴趣的县进行纵向评估，并比较在区域诊所与主要神经科诊所就诊的患者差异。
区域诊所开业后，北部县的转诊量增长速度明显高于服务区域内的其他县。这导致了中心诊所和辐条诊所就诊患者的增加。区域诊所确实诊治了比主要诊所病情较轻的患者；然而，主要诊所安排的低复杂性患者总量并未减少。两个诊所的取消和未到诊率似乎都未受到影响。
区域“辐条”诊所的开业导致转诊量增加，超过了诊所所能承受的能力。因此，中心诊所中来自区域县的就诊患者数量增加，抵消了改善高复杂性患者就医机会的潜在益处。讨论了需求塑造和合理利用作为价值等式一部分的重要性，随后讨论了缓解策略。
