Evidence map›Paper›PMID 33361251›Full record

ArticleNeurology2021

Geographic Variation in Neurologist Density and Neurologic Care in the United States.

Chun Chieh Lin, Brian C Callaghan, James F Burke, Lesli E Skolarus, Chloe E Hill, Brandon Magliocco, Gregory J Esper, Kevin A Kerber

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
58citing papers in PubMed, 1 pooled it
11.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

58 citing papers in PubMed, 1 synthesis or guideline pooled it, 85 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Observational
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Chun Chieh LinFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA. chunchli@med.umich.edu.ORCID 0000-0003-4470-2648
Brian C CallaghanFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
James F BurkeFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Lesli E SkolarusFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Chloe E HillFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Brandon MaglioccoFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Gregory J EsperFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Kevin A KerberFrom the Health Services Research Program, Department of Neurology (C.C.L., B.C.C., J.F.B., L.E.S., C.E.H., K.A.K.), University of Michigan Medical School; Veterans Affairs Healthcare System (B.C.C., J.F.B., K.A.K.), Ann Arbor, MI; American Academy of Neurology (B.M., G.J.E.), Minneapolis, MN; and Department of Neurology (G.J.E.), School of Medicine, Emory University, Atlanta, GA.
Emory University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo describe geographic variation in neurologist density, neurologic conditions, and neurologist involvement in neurologic care.

methodsWe used 20% 2015 Medicare data to summarize variation by Hospital Referral Region (HRR). Neurologic care was defined as office-based evaluation/management visits with a primary diagnosis of a neurologic condition.

resultsMean density of neurologists varied nearly 4-fold from the lowest to the highest density quintile (9.7 [95% confidence interval (CI) 9.2-10.2] vs 43.1 [95% CI 37.6-48.5] per 100,000 Medicare beneficiaries). The mean prevalence of patients with neurologic conditions did not substantially differ across neurologist density quintile regions (293 vs 311 per 1,000 beneficiaries in the lowest vs highest quintiles, respectively). Of patients with a neurologic condition, 23.5% were seen by a neurologist, ranging from 20.6% in the lowest quintile regions to 27.0% in the highest quintile regions (6.4% absolute difference). Most of the difference comprised dementia, pain, and stroke conditions seen by neurologists. In contrast, very little of the difference comprised Parkinson disease and multiple sclerosis, both of which had a very high proportion (>80%) of neurologist involvement even in the lowest quintile regions.

conclusionsThe supply of neurologists varies substantially by region, but the prevalence of neurologic conditions does not. As neurologist supply increases, access to neurologist care for certain neurologic conditions (dementia, pain, and stroke) increases much more than for others (Parkinson disease and multiple sclerosis). These data provide insight for policy makers when considering strategies in matching the demand for neurologic care with the appropriate supply of neurologists.

Indexed as

Health Services AccessibilityNeurologyHumansMedicareNeurologistsUnited States

Identifiers

PMID33361251
PMCPMC7884982
OpenAlexW3117821684

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.