Objective:

Our objective was to characterize the healthcare utilization and access effects of a neurology eConsult program.

Background:

Interprofessional electronic consultations (“eConsults”) can potentially reduce healthcare utilization and improve access to specialty care. However, in neurology, the impacts of eConsult programs compared to in-person referrals remain poorly characterized.

Design/Methods:

We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for neurological complaints via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on sociodemographic characteristics. Our main outcomes were 1) one or more outpatient neurology appointments and 2) median time to neurology appointment in one year following the eConsult or in-person referral ordering date. We used univariable and multivariable logistic regressions to model associations for independent variables and binary outcomes, and a multivariable Cox proportional hazards model for time-to-event variables.

Results:

We identified 828 eConsult patients and 828 controls. In the eConsult group, 378 (45.7%) of referrals were resolved electronically without requiring an in-person visit. Overall, eConsult patients were less likely than control patients to have a neurology appointment within one year (50.0% vs. 57.7%, P=0.002). Compared to control patients who had a neurology appointment, eConsult patients had a significantly lower median wait time [51.0 days (IQR: 26.0, 119.5) vs. 69.5 days (IQR: 29.8, 133.3), P=0.044]. After adjusting for demographic and baseline utilization variables, eConsult patients had significantly lower odds of having one or more neurology appointments compared to control patients (adjusted odds ratio 0.73, 95%CI 0.59-0.89, P=0.002). However, for those who had a neurology appointment, the wait time to the appointment did not significantly differ between eConsult and control patients after adjustments (hazard ratio 1.10, 95%CI 0.96-1.26, P=0.157).

Conclusions:

In comparison to in-person referrals, neurology eConsult requests were associated with reduced likelihood of outpatient neurology appointments in the short-term, but not decreased wait times.