title: Pilot of integrated, colocated neurology in a primary care medical home.
abstract: OBJECTIVE
  Novel health care delivery models are needed to reduce health care use while delivering effective and safe care. We developed a model of a neurologist integrated and colocated in primary care leveraging "curbside," electronic, and traditional consultations. Our objective was to examine the impact on health care resource use of diagnostic testing and referrals for face-to-face neurological consultation and adverse outcomes associated with electronic and curbside consultations.
  
  
  METHODS
  Consecutive patients from December 1, 2014, to March 13, 2015, were included in the analysis about whom contact was made between a primary care clinician and a colocated neurologist.
  
  
  RESULTS
  Over 3.5 months of the pilot, 359 unique patients generated 429 consultations (179 curbsides, 68 electronic consultations, and 182 face-to-face visits). The integrated model resulted in avoidance of 78 face-to-face tertiary neurology consultations, 39 brain magnetic resonance imaging, 50 electromyograms, and 53 other advanced imaging studies. Earlier curbside consultation may have prevented unnecessary testing or face-to-face tertiary neurology consultations in 40 (22%) patients. Earlier face-to-face consultation may have avoided expensive testing in 31 (17%) patients. No cases met criteria for an adverse outcome. The number of referrals to tertiary neurology declined by 64%, and the total number of face-to-face visits per month declined by 25%.
  
  
  CONCLUSIONS
  Colocated neurology in a primary care medical home offers a promising intervention to deliver high-value care.
authors.affiliation: College of Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Young
authors.affiliation: College of Medicine, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Muhamad Y
authors.initials: MY
authors.lastname: Elrashidi
authors.affiliation: College of Medicine, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Crane
authors.affiliation: College of Medicine, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.|College of Medicine, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
mesh_terms: D003943:Diagnostic Techniques, Neurological / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009462:Neurology / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*
keywords: clinical safety; health economics; health services research; patient-centered care; person-centered medicine; value