QUANTITATIVE ASSESSMENT OF NEUROLOGICAL CARE

神经科学知识的爆炸性增长， 十年来，在诊断、预防和治疗方面发生了显着变化， 治疗神经系统疾病。然而，神经系统 医疗服务的提供决定了这些新的进步 最终改善患者的健康状况。提供护理 在美国，神经系统疾病患者正在经历一场 由于医疗保健成本不断上升， 通过“预付费”护理安排投保的人口比例 而不是传统的收费服务系统。没有科学研究 已经进行了这些医疗保健提供系统的变化将如何 影响神经系统疾病患者的健康结果。的目标 本研究旨在定量评估神经系统护理的差异， 在医疗保健提供系统中，使用多发性硬化症作为一种 典型的慢性神经系统疾病具体目标是 研究是：i）比较多发性硬化症患者护理模式 由神经科医生在预付费和收费服务环境中提供，2） 测量多发性硬化症患者的健康状况， 按服务收费制度，3）比较卫生保健服务的利用情况 多发性硬化症患者在这两个医疗保健提供系统中， 调整病例组合，4）比较患者参与新的， 跨系统的实验治疗，以及5）比较 在这两个系统中治疗多发性硬化症。 为了评估多发性硬化症护理模式的差异， 两组神经科医生的国家和地区样本将被 接受调查的：那些在预付费系统中提供医疗保健的人和那些 在一个收费的服务系统中提供护理。实践模式将是 通过比较这些神经学家对一系列 仔细构建与诊断相关的临床情景， 多发性硬化症的治疗评估健康状况，利用率， 参与新的治疗，和成本，两组多个 神经科医生的区域样本中的硬化症患者将被 确定：接受收费服务护理的人和接受护理的人 在预付费系统中。这两组患者将接受调查， 量化的、有效的措施，以确定神经功能障碍， 目前的健康状况和最近的健康状况趋势，最近的健康状况 护理利用，参与新疗法的研究方案， 以及多发性硬化症治疗的费用。将核实利用率数据 通过对一部分病人的医疗记录的回顾。这项研究将 允许开发一个模型，用于定量评估多种 硬化症护理，可适用于其他神经系统疾病。它将 提供客观数据，这些数据可能会影响与 提供神经系统护理。

The explosive growth of knowledge in the neurosciences over the last decade has led to remarkable changes in the diagnosis, prevention, and treatment of neurologic disease. However, the way in which neurological care is delivered determines whether or not these new advancements ultimately result in improved health for patients. The delivery of care for patients with neurological diseases in the US is undergoing a transformation due to spiraling health care costs, with an increasing proportion of the population insured through "prepaid" care arrangements instead of the traditional fee-for-service system. No scientific studies have been conducted of how these health care delivery system changes will affect health outcomes for patients with neurologic disease. The goal of this study is to quantitatively assess differences in neurological care across health care delivery systems, using multiple sclerosis as a representative chronic neurological condition. The specific aims of this study are: i) to compare patterns of care for multiple sclerosis patients provided by neurologists in prepaid and fee-for-service settings, 2) to measure the health status of multiple sclerosis patients in prepaid and in fee-for-service systems, 3) to compare utilization of health care services by multiple sclerosis patients in these two health care delivery systems, adjusting for casemix, 4) to compare patient participation in new, experimental treatments across systems, and 5) to compare the posts of care for multiple sclerosis in these two systems. To evaluate differences in patterns of care for multiple sclerosis, national and regional samples of two groups of neurologists will be surveyed: those delivering health care in a prepaid system and those delivering care in a fee-for-service system. Practice patterns will be assessed by comparing these neurologists' responses to a series of carefully constructed clinical scenarios relevant to the diagnosis and management of multiple sclerosis. To evaluate health status, utilization, participation in new treatments, and cost, two groups of multiple sclerosis patients of the regional sample of neurologists will be identified: those receiving fee-for-service care and those receiving care in a prepaid system. These two groups of patients will be surveyed using quantitative, validated measures to ascertain neurological disability, current health status and recent trends in health status, recent health care utilization, participation in research protocols of new therapies, and costs for multiple sclerosis care. Utilization data will be verified by medical record review of a subsample of patients. This research will permit development of a model for quantitative assessment of multiple sclerosis care that can be applied to other neurological diseases. It will provide objective data that may affect policy initiatives relevant to the delivery of neurological care.