Transforming Neurology Referrals: Impacts of an eConsult Program on Need for Ambulatory Neurology Visits and Time to Appointments

Abstract

Background:

Interprofessional electronic consultations (eConsults) can improve access to specialty care and potentially reduce the need for in-person visits. However, their impact on health care utilization remains poorly characterized.

Methods:

We conducted a retrospective, 1:1 propensity score-matched cohort study comparing patients referred for neurology evaluations via an eConsult or a traditional (in-person) referral at an urban academic medical center. Groups were matched by sociodemographic characteristics. The primary outcome was attendance of an outpatient neurology visit within 12 months of a referral or an eConsult. The secondary outcomes included the time to the first neurology visit within 6 and 12 months. Multivariable logistic regression and Cox proportional hazards models evaluated the outcomes.

Results:

We identified 828 patients in each group between October 2019 and December 2023. At 12 months, eConsult patients were significantly less likely to attain the primary outcome compared with traditional referral patients (50.0% vs. 57.7%, p = 0.002), with multivariable analysis confirming significantly lower odds (odds ratios [OR]: 0.73, 95% CI: 0.60–0.89, p = 0.002). In the 6-month analysis, eConsults were associated with a significantly faster time to visit (45 vs. 59 days, p = 0.01), confirmed in adjusted Cox analyses (hazard ratio [HR]: 1.29, 95% CI: 1.12–1.49, p < 0.001). Over 12 months, the time to the neurology visit was shorter for eConsult patients by 19 days (p = 0.044), but these differences were not significant in adjusted Cox analyses (HR: 1.11, 95% CI: 0.98–1.27, p = 0.11).

Conclusions:

Neurology eConsults were associated with lower follow-up visit rates and faster access to care in the short term, supporting their potential role in accelerating access to neurological expertise and reducing the need for in-person visits.