Specialty Classifications of Physicians Who Provide Neurocritical Care in the United States
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ORIGINAL ARTICLE
Specialty Classifications of Physicians Who Provide Neurocritical Care in the United States Andrew Martin1,4, Monica L. Chen1, Abhinaba Chatterjee1, Alexander E. Merkler1,2, Caroline D. Chung1, Xian Wu3, Nicholas A. Morris5 and Hooman Kamel1,2* © 2018 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease. Methods: Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in lifethreatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI). Results: Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5–28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5–3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3–26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2–43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients’ county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1–8.1). Conclusions: Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries. Keywords: Neurocritical care, Physician specialty, Staffing model, Care delivery, Unit organization
*Correspondence: [email protected] 1 Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 407 East 61 St, New York, NY 10065, USA Full list of author information is available at the end of the article
Introduction The field of critical care medicine emerged in t
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