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.
