Operational Impact of Neurology Rural Access Model: Reflections on the Importance of Demand-Shaping

Area of Science:

• Neurology
• Health Services Research
• Healthcare Operations

Background:

• Increasing demand for specialty neurologic care strains health systems with workforce shortages.
• Investigating innovative care delivery models is crucial for meeting patient needs.
• A hub-and-spoke model with advanced practice providers (APPs) and remote physician oversight is explored.

Purpose of the Study:

• To assess the operational impact of a regional neurology clinic staffed by APPs.
• To evaluate the effectiveness of a hub-and-spoke model in serving lower-complexity patients.
• To analyze changes in referral volumes, patient complexity, and access metrics.

Main Methods:

• Retrospective, cross-sectional study design.
• Analysis of referral volumes, cancellation/no-show rates, and patient complexity.
• Longitudinal evaluation of metrics before and after the regional clinic's establishment.
• Comparison of patients seen at the regional clinic versus the primary neurology practice.

Main Results:

• Referral volumes from targeted rural counties significantly increased post-clinic opening.
• The regional clinic primarily served lower-complexity patients.
• Total low-complexity patient volume at the primary practice did not decrease.
• Cancellation and no-show rates remained unaffected.

Conclusions:

• The regional clinic generated high referral volumes, exceeding its capacity and increasing hub clinic load.
• The model did not improve access for high-complexity patients as intended.
• Demand-shaping and appropriate utilization are critical for optimizing such models.
• Strategies for mitigating excess demand and ensuring efficient resource allocation are necessary.