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Abstract Details

Healthcare Utilization Impacts of a Neurology eConsult Program at an Academic Medical Center
General Neurology
P1 - Poster Session 1 (11:45 AM-12:45 PM)
2-003
Our objective was to characterize the healthcare utilization and access effects of a neurology eConsult program.
Interprofessional electronic consultations (“eConsults”) can potentially reduce healthcare utilization and improve access to specialty care. However, in neurology, the impacts of eConsult programs compared to in-person referrals remain poorly characterized.
We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for neurological complaints via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on sociodemographic characteristics. Our main outcomes were 1) one or more outpatient neurology appointments and 2) median time to neurology appointment in one year following the eConsult or in-person referral ordering date. We used univariable and multivariable logistic regressions to model associations for independent variables and binary outcomes, and a multivariable Cox proportional hazards model for time-to-event variables.
We identified 828 eConsult patients and 828 controls. In the eConsult group, 378 (45.7%) of referrals were resolved electronically without requiring an in-person visit. Overall, eConsult patients were less likely than control patients to have a neurology appointment within one year (50.0% vs. 57.7%, P=0.002). Compared to control patients who had a neurology appointment, eConsult patients had a significantly lower median wait time [51.0 days (IQR: 26.0, 119.5) vs. 69.5 days (IQR: 29.8, 133.3), P=0.044]. After adjusting for demographic and baseline utilization variables, eConsult patients had significantly lower odds of having one or more neurology appointments compared to control patients (adjusted odds ratio 0.73, 95%CI 0.59-0.89, P=0.002). However, for those who had a neurology appointment, the wait time to the appointment did not significantly differ between eConsult and control patients after adjustments (hazard ratio 1.10, 95%CI 0.96-1.26, P=0.157).
In comparison to in-person referrals, neurology eConsult requests were associated with reduced likelihood of outpatient neurology appointments in the short-term, but not decreased wait times.
Authors/Disclosures
Margaret H. Downes
PRESENTER 		Miss Downes has nothing to disclose.
Soonmyung Hwang (Icahn School of Medicine at Mount Sinai) Mr. Hwang has nothing to disclose.
Mark Dakov, BS Mr. Dakov has nothing to disclose.
Parul Agarwal Parul Agarwal has nothing to disclose.
Benjamin R. Kummer, MD, FAAN Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for AlphaSights. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syapse. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuraHealth. Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for RONIN. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Global. Dr. Kummer has received personal compensation in the range of $0-$499 for serving as a Consultant for GLG. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Petauri Kinect. Dr. Kummer has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for 好色先生 . Dr. Kummer has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JMIR. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Yoeli Gottlieb Etra LLP. Dr. Kummer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for The Ashley Law Firm. Dr. Kummer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Burns White Attorneys at Law. Dr. Kummer has stock in Syntrillo. The institution of Dr. Kummer has received research support from Icahn School of Medicine at Mount Sinai. Dr. Kummer has a non-compensated relationship as a Vice Chair Telehealth Subcommitte with 好色先生 that is relevant to AAN interests or activities. Dr. Kummer has a non-compensated relationship as a Vice Chair Quality Informatics Subcommittee with 好色先生 that is relevant to AAN interests or activities.