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      Neurology eConsults at Penn State Health: What, Why, and How?

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          Abstract

          eConsults provide a mechanism for specialists to provide guidance to their colleagues to allow them to manage patients in primary care settings. The patient receives access to specialist expertise, avoids the long wait time and high costs associated with an office visit, and maintains relationship continuity with the primary care physician (PCP). The PCP has dynamic access to specialist expertise and an opportunity for attainting a higher comfort level with chronic neurological care comanagement. Patient referrals for specialty care are high, while there has been projected shortage in nonprimary care specialties. 1, 2 The increasing prevalence of neurologic diseases associated with an aging population will likely continue to increase the demand for neurologists. 2, 3

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          Supply and demand analysis of the current and future US neurology workforce.

          This study estimates current and projects future neurologist supply and demand under alternative scenarios nationally and by state from 2012 through 2025.
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            Trends in physician referrals in the United States, 1999-2009.

            Physician referrals play a central role in ambulatory care in the United States; however, little is known about national trends in physician referrals over time. The objective of this study was to assess changes in the annual rate of referrals to other physicians from physician office visits in the United States from 1999 to 2009. We analyzed nationally representative cross-sections of ambulatory patient visits in the United States, using a sample of 845 243 visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2009, focusing on the decade from 1999 to 2009. The main outcome measures were survey-weighted estimates of the total number and percentage of visits resulting in a referral to another physician across several patient and physician characteristics. From 1999 to 2009, the probability that an ambulatory visit to a physician resulted in a referral to another physician increased from 4.8% to 9.3% (P < .001), a 94% increase. The absolute number of visits resulting in a physician referral increased 159% nationally during this time, from 41 million to 105 million. This trend was consistent across all subgroups examined, except for slower growth among physicians with ownership stakes in their practice (P = .02) or those with the majority of income from managed care contracts (P = .007). Changes in referral rates varied according to the principal symptoms accounting for patients' visits, with significant increases noted for visits to primary care physicians from patients with cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms. The percentage and absolute number of ambulatory visits resulting in a referral in the United States grew substantially from 1999 to 2009. More research is necessary to understand the contribution of rising referral rates to costs of care.
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              Reduced Cost Of Specialty Care Using Electronic Consultations For Medicaid Patients

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                Author and article information

                Journal
                TMT
                Telehealth and Medicine Today
                Partners in Digital Health
                2471-6960
                25 November 2019
                2019
                : 4
                : 10.30953/tmt.v5.158
                Affiliations
                [1 ]Department of Neurology, Penn State Health, Hershey, PA, USA
                Author notes
                Corresponding Author: Aiesha Ahmed, aahmed1@ 123456ennstatehealth.psu.edu
                Article
                158
                10.30953/tmt.v5.158
                d0a1a651-9d1a-46ff-bf10-2ff247bd0075
                © 2019 Aiesha Ahmed

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Categories
                Prespective, Opinion, and Commentary on a Current Issue Impacting the Sector

                Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
                Fast Healthcare Interoperability Resources,FHIR,Neurological Care,Teleneurology Services,Interoperable data exchange,Blockchain,Cost-Effectiveness/Economic,Voice biometrics,Electronic Medical Records,Current Practice,Models of Care,eCONSULT

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