title: Study of outpatient neurological care in the Region of Madrid: The impact of implementing free choice of hospital.
abstract: BACKGROUND
  A new model permitting free choice of hospital has been introduced in the Region of Madrid. This may result in changes in how outpatient neurological care is provided and managed. The purpose of this study is to analyse initial visits to a general neurology department in the Region of Madrid and record the health district corresponding to each patient's residence.
  
  
  METHODS
  Observational and prospective study of a cohort of patients making initial outpatient visits to a neurology department between 16 September 2013 and 16 January 2014.
  
  
  RESULTS
  The study included 1109 patients (63.8% women, mean age 55.2±20.5). The most frequent diagnostic groups were periodic headache, cognitive disorders, and neuromuscular diseases. Non-neurological diseases were diagnosed in 1.1% of the cases. The mean time of delay was 7.2±5.1 days. Residents within the hospital's health district made up 73.8% of the total, while 26.2% chose a hospital outside of the health district corresponding to their residences. In the latter group, 59.5% made the choice based on the level of care offered, while 39.7% changed hospitals due to shorter times to consultation. The patients who came from another health district were younger (50.7 vs 57.3, P<.0001) and had a lower rate of discharges on the first visit (16.4% vs 30.1%, P<.0001).
  
  
  CONCLUSIONS
  The model of free choice of hospital delivers significant changes in healthcare management and organisation. Reasons given for choosing another hospital are more ample experience and shorter delays with respect to the home district hospital. Management of patients from outside the health district is associated with greater complexity.
authors.affiliation: Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España. Electronic address: jordimatiasguiu@hotmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Matías-Guiu
authors.affiliation: Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: García-Azorín
authors.affiliation: Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: García-Ramos
authors.affiliation: Servicio de Admisión, Hospital Clínico San Carlos, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Basoco
authors.affiliation: Servicio de Admisión, Hospital Clínico San Carlos, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Elvira
authors.affiliation: Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Matías-Guiu
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002755:Choice Behavior; D003695:Delivery of Health Care; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000600:supply & distribution; D011446:Prospective Studies; D013030:Spain; D061665:Time-to-Treatment
keywords: Asistencia neurológica ambulatoria; Epidemiology; Epidemiología; Gestión sanitaria; Healthcare management; Outpatient neurological care