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Abstract Details

Focus on Equitable Delivery of Neurologic Care: from ED to Clinic
Health Care Disparities
P6 - Poster Session 6 (5:30 PM-6:30 PM)

Neurologic disorders are a growing burden on public health and are significant contributors to mortality and disability worldwide. Unequal access to and utilization of neurologic care has been shown for multiple neurologic diseases. Neurology referrals can be unreliable with high degree of loss-to-follow-up, leading to worse neurologic health outcomes. Neurologic disorders have also been shown to disproportionately affect. 

Our goal was to examine the impact of various demographic and socioeconomic variables on attendance at neurology referral appointments from an ED visit in a large tertiary care center. We hypothesized that healthcare inequities would impact neurologic care after an ED visit.
We examined a retrospective cohort of adult patients evaluated in the ED over a 24-month period (January 2019-December 2020). Patient demographics were collected from all (991) patients who were subsequently referred to the outpatient neurology clinics from the ED. Chart records were reviewed to examine the primary outcome of outpatient Neurology follow-up. Univariate and multivariate regression models were used to assess the impact of age, sex, race-ethnicity, insurance status, and social vulnerability index (SVI) on outpatient follow-up. 

Our cohort had a significantly higher proportion of Black patients, whereas a similar proportion of female patients when compared to city census data. Different insurance types were well represented in our cohort. Most common referral diagnoses included: seizures, headache, neuropathy, and stroke. There was a high proportion of patients with poor outcomes (lost to follow-up or never followed-up). In univariate and multivariate logistic regression models, Black and uninsured patients were less likely to follow-up. 

Disparities in neurological care exist. Identifying groups with higher risk of non-adherence can help clinicians identify at-risk individuals/groups. Our goal is to work with the healthcare systems to implement structural changes, including more efficient and equitable resource allocation, to assure equal access to neurological care. 

Mimi T. Giang (Washington University School of Medicine in St. Louis)
Ms. Giang has nothing to disclose.
Enmanuel Perez, MD, PhD (Department of Neurology, Washington University School of Medicine in St. Louis) Dr. Perez Martinez has nothing to disclose.