Taxonomy I Part III-B (Neurology)

(17 March 2006 20:15)

NATIONAL PROJECT ON THE COMMUNITY BENEFITS

OF FAMILY MEDICINE RESIDENCY PROGRAMS

CUMULATIVE QUESTIONNAIRE RESPONSES

Taxonomy Section I Part IIIB

(Neurology)

SD I.13k(1.1) (SD I.13k(2) (L32)) Does your residency program provide the following kinds of specialty care?

k. Neurology?  Yes__ No __

Yes:

Whittier

Pomona

Arrowhead

Loma Linda

Stockton

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

SD I. 13k(1.2) (SD I.13k(3)) If you do provide neurology, are these services provided as normal family health center appointments? Yes __ No __

Yes:

Whittier

Pomona

Loma Linda

Stockton

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Klamath Falls

Lehigh Valley

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

No:

Arrowhead

SD I.13k(1.3) (SD I.13k(4)) If you do provide neurology, are these services provided during special clinics?

Yes __ No __

If yes, what is the number of patients seen?  What revenues are generated in each specialty service?

Yes:

Arrowhead                   (200/yr)

Loma Linda                  (40/yr)

Stockton                      (8 per clinic; revenues are generated)

No:

Whittier

Pomona

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

SD I.13k(1.31) (AJ) Do you refer all patients with new onset severe headache to neurologists? Yes __ No __

Yes:

Las Vegas

No:

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire)

No:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Arrowhead

Loma Linda

Kaiser LA

Tyler

No Response:

Lehigh Valley

SD I.13k(1.32) (AJ) If the answer to SD I.13k(1.31) is no, do your residents routinely order CT scans for new onset headaches? Yes __ No __

Yes:

Springfield

Lexington

No:

Fresno                          (We order CT scans for crescendo severe headaches.  This is a clinical judgment question)

Glasgow                       (Emphasizing “routinely”)

E-mail responses (2005 Questionnaire)

Yes:

UC Irvine

Riverside

Decatur

Mercy Toledo

Kaiser LA                    (adjective “severe” written in prior to “headaches”)

Tyler

No:

UCSD Traditional

UCSD St Vincent

White Memorial

Modesto                      (“routinely” is bolded with a question mark)

Indiana U Methodist

Whittier

Arrowhead

Glendale                       (“Only with neuro signs, or suspicious hx”)

Dayton Community

Mercer

Klamath Falls               (“Usually we use MRI”)

Conditional Response:

Loma Linda                  (“Depends on Severity”)

No Response:

Lehigh Valley

SD I.13k(1.32.1) (AJ) If the answer to SD I.13k(1.31) is no, do your residents routinely order CT scans for new onset severe headaches? Yes __ No __

Conditional Response:

OHSU Portland            (Depends on the definition of “routinely” and “severe”)

SD I.13k(1.33) (AJ) Do you routinely refer all new onset seizures to neurology? Yes __ No __

Yes:

Las Vegas

Springfield

Glasgow

OHSU Portland

No:

Fresno

Lexington

E-mail responses (2005 Questionnaire)

Yes:

UCSD Traditional

UC Irvine

White Memorial

Modesto

Arrowhead

Loma Linda

Dayton Community

Lehigh Valley

Kaiser LA                    (“new onset” underlined)

Tyler

No:

UCSD St Vincent

Riverside

Indiana U Methodist

Whittier

Glendale                       (“Yes (in adults only)”)

Decatur

Mercer

Mercy Toledo              (“No, not routinely”)

Klamath Falls

SD I.13k(1.34) (AJ) If the answer to SD I.13k(1.33) is no, do you order CT scans routinely for new onset seizures? Yes __ No __

Yes:

Fresno

Lexington

E-mail responses (2005 Questionnaire)

Yes:

UCSD St Vincent

Riverside

Glendale                       (“Likely (in adults)”)

Decatur

Mercer

Mercy Toledo

No

Indiana U Methodist

Whittier

Klamath Falls               (“Usually we use MRI”)

SD I.13k(1.35) (AJ) Do you routinely refer carpal tunnel syndrome patients to neurology? Yes __ No __

No:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire)

Yes:

Loma Linda

No:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

SD I.13k(1.36) (AJ) Do you provide follow-up care for seizures in your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

SD I.13k(1.37) (AJ) Do you care for multiple sclerosis patients in the family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow                       (Historically, yes; no active MS cases)

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

No:

Decatur

NPCB P2 I.13k(1.37.1) Does your residency program provide a  range of services for multiple sclerosis patients, including diagnosis, management and treatment, in the family medicine center?

Yes __ No __

Yes:

Sparrow                       (We would not manage an MS patient all by ourselves, but as part of a team, including neurologists.)

Ventura                        (We provide diagnosis and ongoing management in conjunction with neurologists.)

Long Beach                  (We co-manage with neurology.)

U Penn

Jefferson                       (We diagnose and manage, but do not develop initial treatment regimens)

Shadyside                     (We do so in consultation with neurology and sometimes also with oncology)

Johnstown                    (Usually we do not diagnose; we co-manage with a neurologist)

Altoona

Fairfax

No:

Huntsville                      (We tend to refer MS patients to neurology)

Crozer-Keystone

McKeesport

Oahu

St Margaret

NPCB P2 I.13k(1.37.2) Does your family medicine center refuse to provide ongoing care for a multiple sclerosis patients? Yes __ No __

Yes:

Huntsville

No:

Sparrow

Ventura

Long Beach

U Penn

Crozer-Keystone

Jefferson

McKeesport

Oahu

Shadyside

Johnstown

Altoona                        (We do not refuse anything)

St Margaret

Fairfax

SD I.13k(1.38) (AJ) Would you expect that a neurology referral from your residency program would be seen by a neurologist within two weeks? Yes __ No __

Yes:

OHSU Portland

No:

Las Vegas

Fresno

Springfield                    (it usually takes 3 months, unless a doctor says that it is an emergency)

Glasgow

Lexington

E-mail responses (2005 Questionnaire)

Yes:

UC Irvine

White Memorial

Indiana U Methodist

Whittier

Decatur

Mercer

Klamath Falls

Kaiser LA

Tyler

No:

UCSD Traditional

UCSD St Vincent

Riverside

Modesto

Arrowhead

Loma Linda

Glendale

Dayton Community

Lehigh Valley

Mercy Toledo

SD I.13k(1.39.1) (AJ) If a neurological cause of syncope is suspected, do you care for the patient in the family medicine center?

Yes __ No __

Yes:

Las Vegas

Fresno                          (We might admit them to our family medicine service)

Springfield

Glasgow

OHSU Portland

No:

Lexington

E-mail responses (2005 Questionnaire)

Yes:

UCSD Traditional

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Maybe:

UCSD St Vincent         (“Maybe, depends on the workup results & dx”)

SD I.13k(1.39.2) (AJ) Are stroke inpatients discharged to your family medicine center for follow-up care? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

SD I.13k(1.4) (SD I.13k(5)) Describe the kinds of neurology that typically takes place within the family health center (whether as normal appointments or during special clinics):

Glendale                       (CVA, strokes; will evaluate onset of seizures; will refer out but will do plan maintenance)

OU Tulsa                     (neurological evaluation; no EEGs, EMGs)

OU Oklahoma City      (headaches; seizures; strokes; MS; hemostasis)

Dayton Community       (neurological exams; specific neurological problems; we order EEGs, but do not read)

Miami Valley                (seizures, TIA; stroke; dementia (on our own patients and those we are co-managing)

Decatur                        (neuropathies; strokes; no MS patient care)

Mercer                         (stroke; Parkinson’s; seizures; headaches; dementia; MS; PLMD; MR)

Natividad                     (headaches; dementia; stroke follow-up; seizure disorders; Parkinson’s)

Klamath Falls               (assessment and treatment of MS; post-CVA care; migraine and other headaches; neuropathies; dementia; deliriums; concussions)

Lehigh Valley                (MS patients; headaches; ALS patients; seizure patients; CVAs)

Mercy Toledo              (everything short of surgery; all general problems)

Kaiser LA                    (seizures; the family medicine department’s geriatric faculty run the institution’s Alzheimer’s and dementia clinics)

Tyler                            (monofilament testing; general neurologic exams; lumbar punctures)

SD I.13k(1.4.1) (SD I.13k(5)) Describe any other kinds of neurology that typically takes place within the family health center (whether as normal appointments or during special clinics):

Las Vegas                    (headaches; primary care for Parkinson’s disease patients; management of Alzheimer’s; neuropathies; post-polio syndrome; stroke patients)

Fresno                          (Bells palsy; Guiane-Barre)

Springfield                    (Bells palsy; headache; gait; Parkinson’s disease; tremors)

Glasgow                       (diagnose and manage migraine headaches, post-herpetic neuralgia; chronic pain)

Lexington                     (peripheral nerve diseases; degenerative brain diseases and dementia; neuropathic pain; cord impingement syndromes)

OHSU Portland            (migraine; Bells palsy; ALS; Alzheimer’s, other dementia; vertigo; diplopia; long list of diagnoses)

NPCB P2 I.13k(1.4.2) For what conditions would your residency program refer patients to neurologists?  What is the expected wait time before the patient is seen?

Sparrow                       (Difficult migraine patients; neurogenerative diseases like MS, ALS, stroke patients)

Huntsville                      (Interferon treatments or new biologic treatments)

Ventura                        (Diagnosis and management of obscure or difficult neurological problems, such as difficult to manage seizure disorder patients, MS, degenerative neurological conditions, ALS, adrenal leukrodystrophy)

Long Beach                  (Diagnostic dilemmas, sometime within a managed care program, only neurologists can order MRIs, some pharmaceuticals for MS are very expensive and are limited to neurologists.  The wait for a neurologist referral is sometimes 6 weeks.)

U Penn                         (Referrals are physician specific; the wait times are 1 day to 1 month.)

Crozer-Keystone          (Seizure management; headache management; some chronic pain; 2 week wait)

Jefferson                       (We refer for seizure disorders; 8-12 week wait)

McKeesport                 (Vague, undiagnosed problems like peripheral neuropathies; MS; Parkinson’s; diagnostic issues; wait time is 2 weeks)

Oahu                            (Refractory headaches; seizure disorders; MS; some bad balance problems; hypertensive encephalopathy; AMS; inpatient neurology)

Shadyside                     (Complex neurological conditions; refractory seizures; specialized diagnostic testing)

Johnstown                    (Advanced neurologic problems; unresolved pain management; advanced motor problems; seiaures; we would do ongoing management after the neuro evaluation; in patient problems are seen within a day, headaches a week, chronic pain, a month)

Altoona                        (Problems we cannot diagnose; consults for pregnant patients with seizures out of control)

St Margaret                  (Complex seizures; multiple sclerosis; complex strokes; gait disorders such as Parkinson’s)

Fairfax                          (Referrals seen within a week; acute strokes; initial evaluations of seizure disorders; chronic, recalcitrant migraines; difficult to control seizures; persistent neurologic deficits; consultation, in some cases, of dementia)

*NPCB P2 I.  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient of outpatient settings (or both)?

a) migraine headaches?         Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

b) seizures?                            Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

c) tremor?                               Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

d) restless leg?                       Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

e) Parkinson’s disease?         Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

f) stroke/TIA?                        Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Last Updated (17 August 2006 20:09)