From Fragmentation to Standardization: Developing an Outpatient Autoimmune Neurology Clinic
Sarah Fredrich1, Haroon Ahmad1, Lily Pham1, David Benavides1
1University of Maryland School of Medicine
Objective:
To describe the development of a rapid-access outpatient autoimmune neurology clinic using scalable workflows and clinical scoring tools, and to evaluate its impact on timeliness, diagnostic accuracy, and standardization of care for suspected autoimmune encephalitis (AE) and paraneoplastic neurologic syndromes (PNS).
Background:
Care for patients with suspected AE and PNS is often fragmented, leading to delayed diagnosis, unnecessary testing, and inconsistent use of validated diagnostic frameworks. Dedicated subspecialty clinics may improve efficiency and diagnostic accuracy, but practical models and implementation strategies remain underreported.
Design/Methods:
We established a rapid-access outpatient autoimmune neurology clinic using structured referral triage, templated documentation, and coordinated diagnostic pathways. Standardization included systematic application of APE2 and PNS-CAREs scores to guide diagnostic testing and antibody interpretation. We retrospectively analyzed 50 consecutive patients, evaluating the time to evaluation, time to diagnostic studies (MRI, EEG, lumbar puncture, malignancy screening) using clinic workflows versus pre-referral timelines, antibody panel utilization, and concordance between referral and final diagnoses.
Results:
Fifty patients were evaluated following screening of 77 referrals. The mean time to first appointment was 17 days. Most patients had extensive prior workup, including neuroimaging and antibody testing. The clinic model enabled systematic reinterpretation of prior results and reduced time to key diagnostic studies including MRI Brain, EEG, and lumbar puncture. Twenty-two percent of serum and 25% of CSF antibody panels required repeat testing for gold-standard assessment. The application of APE2 and PNS-CAREs scores improved diagnostic stratification and reduced unnecessary testing. Referral diagnoses were frequently revised following standardized evaluation, highlighting variability in pre-referral diagnostic accuracy.
Conclusions:
A structured autoimmune neurology clinic model enables standardized, high-value evaluation of suspected AE and PNS. Integration of clinical scoring systems, centralized data review, and coordinated diagnostic workflows improved consistency in antibody testing and diagnostic decision-making. This model provides a scalable framework for other centers seeking to develop subspecialty autoimmune neurology programs.
Generative AI Usage
Yes, used generative AI in the drafting or editing in this abstract.
Tool, version, and prompt(s) used, as well as area of the abstract affectedThe authors used Chat GPT and used the prompt “I want to edit a draft of an abstract for submission to the AAN meeting for autoimmune neurology. The abstract guidelines have been uploaded. I have uploaded a draft of a paper from which the abstract is based. I want to focus on the development of a subspecialty autoimmune clinic (lessons learned, tools for other neurologists to launch their own centers) and standardization of approach to potential AIE/PNS patients using APE2 and PNSCAREs scores. Edit for concise and clear language, alternative summarization of primary endpoints based on paper” for text generation in the Objective, Background, Design/Methods, Results.
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