title: Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset.
abstract: OBJECTIVE
  To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization.
  
  
  METHODS
  The Optum proprietary claims dataset (2010-2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third--party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.
  
  
  RESULTS
  For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD).
  
  
  CONCLUSIONS
  Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization.
authors.affiliation: From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI. john.p.ney@gmail.com.
authors.forename: John P
authors.initials: JP
authors.lastname: Ney
authors.affiliation: From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
authors.forename: Barbara
authors.initials: B
authors.lastname: Johnson
authors.affiliation: From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
authors.forename: Tom
authors.initials: T
authors.lastname: Knabel
authors.affiliation: From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
authors.forename: Karolina
authors.initials: K
authors.lastname: Craft
authors.affiliation: From the Department of Neurology (J.P.N.), University of Washington, Seattle; Optum Insight (B.J., T.K.), Eden Prairie, MN; the Department of Human Services (K.C.), American Academy of Neurology, Minneapolis, MN; and Lifespan Physicians PSO (J.K.), Rhode Island Hospital, Providence, RI.
authors.forename: Joel
authors.initials: J
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000191:economics / Q000628:therapy*; D009462:Neurology / Q000191:economics / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*