Faculty Bibliography

BACKGROUND AND OBJECTIVES/OBJECTIVE:Implementation of telemedicine expanded options for outpatient neurology care. It remains uncertain which new neurology patients can be appropriately evaluated virtually. We compared subsequent health care utilization after virtual vs in-person new patient neurology visits across 3 academic medical centers. METHODS:We conducted a retrospective multicenter cohort study of adults with a new outpatient neurology visit from September 2020 through December 2021 using the Vizient Clinical Data Base and Clinical Practice Solutions Center databases. Virtual and in-person patients were matched 1:1 using propensity scores incorporating demographics, clinical characteristics, time period, and previous health care utilization. Outcomes were analyzed overall and stratified by neurologic chief complaint category and institution. We compared rates of subsequent neurologic clinic follow-up, emergency department (ED) visits, and hospitalizations after virtual and in-person encounters. Testing and all-cause ED visits/hospitalizations were also assessed. RESULTS:= 0.13, respectively). Analyses by chief complaint found that 90-day follow-up was higher after in-person visits for dementia, whereas 30- and 90-day follow-up was higher after virtual visits for Parkinson disease and multiple sclerosis, and 90-day follow-up was higher after virtual visits for headache. Testing was more frequent after in-person visits for certain chief complaints. DISCUSSION/CONCLUSIONS:In this propensity score-matched multicenter cohort, new neurology patients seen virtually had similar downstream utilization as those seen in-person, including comparable 90-day follow-up and similar neurologic and all-cause ED visits and hospitalizations. Although follow-up varied modestly by chief complaint and testing was more frequent after some in-person visits, no major differences emerged overall.

A 65-year-old woman presented with 3 months of progressive hand weakness, initially with distal-predominant symptoms. EMG was notable for diminished amplitudes in bilateral radial nerves without evidence of conduction block and with normal sensory nerve action potentials. Anti-acetylcholine receptor and antistriated muscle antibodies were positive, but subsequent EMG did not reveal abnormalities on repetitive nerve stimulation. Muscle biopsy was performed, revealing extensive inflammatory infiltrates with significant associated fibrosis. This case discusses the approach to localization within the motor pathway and the use of serologic studies, imaging, and electrodiagnostic testing to supplement history and examination.

BACKGROUND AND OBJECTIVES/UNASSIGNED:With more women entering the medical workforce, caregiving challenges and family-work conflicts are of growing importance to today's neurologists. The aim of this study was to assess the impact of caregiver (CG) status on academic achievements in neurology, analyze the division of labor and time devoted to domestic responsibilities, and measure family-work conflict in US academic neurology faculty. METHODS/UNASSIGNED:analyses as appropriate, with CGs vs noncaregivers (N-CGs) serving as the independent groups. RESULTS/UNASSIGNED:= 0.034). DISCUSSION/UNASSIGNED:Although the caregiving burden did not directly affect academic productivity, it significantly increased FWC in US academic neurology faculty surveyed. Female CG faculty disproportionately shouldered domestic and household responsibilities. Beyond recognizing CG challenges, advocating for a change in paradigm and providing solutions to these pervasive issues could be instrumental in preventing further attrition of professionals from our field, particularly women with caregiving roles.

BACKGROUND AND OBJECTIVES/UNASSIGNED:Burnout is a pervasive occupational hazard for neurologists-undermining their well-being, jeopardizing patient safety and satisfaction, limiting access to care, and inflating health care costs. Well-designed appreciation and recognition practices may help mitigate some of its key drivers. This pilot study evaluates faculty perspectives on appreciation strategies in an academic neurology department. We used the Moffitt Provider Appreciation Assessment (MPAA), which assesses the types of appreciation methods respondents value, regardless of whether those practices are currently implemented in their workplace. METHODS/UNASSIGNED:A cross-sectional survey was conducted among full-time clinical faculty in the Department of Neurology at NYU Grossman School of Medicine. The survey included demographics, the MPAA, the single-item Mini-Z burnout inventory to assess self-reported burnout levels, and an intent-to-leave question. MPAA responses were analyzed for frequencies, and the association between burnout and intent to leave was examined. RESULTS/UNASSIGNED:< 0.00001). Because the scores for self-reported burnout and intent to leave reflect current work conditions while MPAA scores capture enduring personal values, MPAA rankings cannot be compared directly with burnout or turnover metrics. DISCUSSION/UNASSIGNED:Neurology clinical faculty prioritized appreciation methods that directly address clinical work, underscoring the value of implementing tailored recognition practices that may reduce burnout. The methodology used in this pilot study can be adapted for broader application in other settings. After identifying faculty preferences, health care organizations can implement meaningful, transparent, and inclusive appreciation strategies that have the potential to strengthen physician relationships, promote well-being, and support a sustainable workforce.

Neurologists engaged in meaningful and satisfying work are positioned to advance the field through research, education, and patient care. On the other hand, neurologists are at elevated risk for burnout and career dissatisfaction, influenced by personal characteristics but driven primarily by external factors at work unit, organizational, and systemic/societal levels. Recognizing and attending to the full range of factors that influence neurologist well-being is necessary to avoid detrimental consequences on patients, clinicians, organizations, and public health. This discussion will review the current state of well-being in neurology, explore drivers and outcomes, and present strategies for improving career satisfaction.

Documentation, coding, and billing (claims submission) are foundational to neurologic practice in the United States, enabling accurate reimbursement, effective communication, and data-driven advancements in patient care, research, and education. Neurologists navigate complex regulatory frameworks and evolving payer guidelines, requiring meticulous attention to diagnostic coding, evaluation and management (E/M) services, and procedure-specific requirements. This chapter examines critical aspects of neurologic billing and coding, including ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) for diagnostic accuracy, updated E/M guidelines emphasizing medical decision-making and time, and new telemedicine codes. It highlights the best practices for procedure coding and the use of digital health technologies. The challenges posed by prior authorization are explored, alongside potential solutions like artificial intelligence-driven tools and policy reform. By prioritizing precision, compliance, and technological adaptation, neurologists can enhance patient outcomes, support practice sustainability, and contribute to the broader goals of equitable, efficient, and innovative neurologic care.

Mobile applications are widely used in epilepsy, although their impact on clinical effectiveness (CE) and their feasibility, acceptability, and usability (FAU) remain unclear. We conducted a systematic review investigating CE and FAU of epilepsy mobile applications using MEDLINE and Embase from database inception to June 21, 2024. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. The protocol was registered on PROSPERO (CRD42019134848). In duplicate, we determined study quality using the Newcastle-Ottawa Quality Assessment Scale (NOQAS) and the Joanna Briggs Critical Appraisal Checklist (to determine eligibility for inclusion), risk of bias using the Cochrane Risk of Bias tool, and usability study quality using the 15-point Silva scale. We identified 8953 studies, of which 20 were included. Twelve (60.0%) addressed CE, nine (45.0%) acceptability, five (25.0%) usability, and eight (40.0%) feasibility. Five (25.0%) evaluated CE and FAU. Studies comprised prospective cohort (n = 9, 45.0%), pilot (n = 3, 15.0%), randomized controlled trial (n = 7, 35.0%), and pre/post (n = 1, 5.0%) designs. Most apps were used for self-management or to enhance education or communication between patients and providers. Cohort studies demonstrated fair quality (median NOQAS score = 5, interquartile range [IQR] = 5.0-5.8), whereas of seven randomized controlled trials, four (57.1%) had some concern for bias. Usability studies demonstrated high quality (median Silva score = 10, IQR = 10-11). Apps were predominantly intended for patient use (n = 9, 75.0%). Symptom reporting and medication management were the most common app targets in both CE and FAU studies (n = 8, 66.7%; n = 9, 69.2%), although FAU studies more frequently used monitoring or tracking (n = 10, 76.9%) and reminder setting (n = 10, 76.9%) than CE apps (n = 7, 58.3%). Investigations of application use most commonly studied CE and patient-facing apps. Additional high-quality evidence is necessary to evaluate the CE and FAU of app use in epilepsy to work toward the standardization of FAU metrics and development of implementation guidelines.