Abstract Details

Title Factors Influencing the Ordering of MRI Studies in Pediatric Patients with Headache from Two Medical Home/Community Health Center Populations: Costs and Outcomes

Topic Child Neurology/Developmental Neurobiology

Presentation(s) S25 - (-)

Poster/Presentation
Number 006

Background A previous report examined access to pediatric neurology care in two urban medical home environments, using co-located (on-site) v. hospital-based consultations. That report demonstrated that a co-located model was superior in 1) time to new appointment, 2) kept appointment rate( new and return), 3) use of the ED, and 4) rates of hospitalization. This led to an 8-fold difference per annum per patient for overall neurologic costs in a patient population usually considered challenging in terms of containing costs and improving outcomes .

Objective

Design/Methods Records of the two cohorts were reviewed for all patients with diagnoses related to headache. Ordering of MRI, visits to the ED, MRI results, and charges for office visits, ED visits, and MRI studies were tabulated.

Results The co-located care model had 173 cases of headache over the 5-year study period, the traditional referral model 169. The co-located care cohort generated 17 visits to the ED over this period, the traditional cohort 306. This produced a substantial differential in cost of care. The co-located group saw 5 MRI studies ordered, all from ED visits. The traditional care model saw 102 MRI studies generated: 89 from ED visits, 10 by neurology providers , and 3 by primary care providers. All MRI studies were devoid of significant pathological findings in both groups.

Conclusions A co-located care model contained costs significantly, used ED resources less often, and was associated with no difference in diagnostic outcome. The chief source of MRI studies ordered were not PCP offices, but rather the ED. A model of care which keeps this cohort of patients from ED utilization for a chronic health problem was thus associated with cost reduction without adverse effects on outcome.

Authors/Disclosures
David K. Urion, MD, FAAN (Children'S Hospital Boston) PRESENTER	Dr. Urion has nothing to disclose.
Daniel Kantor, MD, FAAN (Medical Partnership 4 MS+)	Dr. Kantor has received personal compensation for serving as an employee of Gateway Institute for Brain Research. The institution of Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Myers Squibb. The institution of Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Janssen. Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CorEvitas, LLC. The institution of Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Osmotica Pharmaceuticals. The institution of Dr. Kantor has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Kantor has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Kantor has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. The institution of Dr. Kantor has received research support from Bristol Myers Squibb. Dr. Kantor has a non-compensated relationship as a HAP with MSFous (MSF) that is relevant to AAN interests or activities. Dr. Kantor has a non-compensated relationship as a Medical Board with MS Views & News that is relevant to AAN interests or activities.
	No disclosure on file

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