Abstract Details

Title Effect of Neurologist Ambulatory Visits on Utilization and Expenditures of Non-Ambulatory Care in the United States

Topic Neurologic ��ɫ��

Presentation(s) P04 - (-)

Poster/Presentation
Number 256

Objective

Background BACKGROUND: Neurologist care is mostly through office-based and outpatient visits (ambulatory care), but the effect of a neurologist ambulatory visit on inpatient, emergency, and home care (non-ambulatory care) is unknown.

Design/Methods DESIGN/METHODS: Survey respondents from the 2002-2009 Medical Expenditure Panel Survey(MEPS), a representative dataset of the civilian non-institutionalized US population, were identified for multiple sclerosis, parkinsonism, epilepsy, and dementia. Data collection included neurologist ambulatory care, age, illness duration, race, income, gender, education, comorbidities, region and year of care. Survey-weighted multivariate regressions were performed on costs and utilization totals for non-ambulatory care for the calendar year including a neurologist ambulatory visit. Subgroup analyses were performed for any condition-related ambulatory care and outcomes for each index condition.

Results RESULTS: 3883 MEPS respondents (weighted sample: 4.3 million US citizens, 95% CI 4.0-4.6m) reported one or more index conditions. Fifty-eight percent reported ambulatory care for the condition, and 29% reported a neurologist visit. Neurologist visits were associated with illness duration, high school graduate education, insurance coverage, and income. For the group seeing a neurologist, the adjusted likelihood of a non-ambulatory event was reduced overall (OR=0.80, p=0.03) and adjusted non-ambulatory care expenditures were reduced by 40% overall (p=0.01), averaging $4983 in savings (p=0.003). Among respondents with any ambulatory care for their condition, those seeing a neurologist had reduced condition-associated non-ambulatory care events(OR=0.64, p=0.001) and costs ((53% reduction,(p<0.001), $1911(p=0.001)). The largest reduction in non-ambulatory care was for dementia patients seeing a neurologist (OR 0.37, p=0.04; $2406 cost-saving in ambulatory care recipients (p=0.013)).

Conclusions CONCLUSIONS: Neurologist ambulatory care is associated with reduced total and condition-related inpatient, outpatient, and home health events and expenditures in patients with chronic neurological conditions.

Authors/Disclosures
John Ney, MD, MPH, FAAN (VA Connecticut) PRESENTER	Dr. Ney has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Ney has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Clinical Practice.
David N. Van Der Goes, PhD (University of New Mexico)	Dr. Van Der Goes has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Albuquant LLC.
Silvia Messina (AOU Policlinico Vittorio Emanuele)	No disclosure on file

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