How Much More Time Neurologic Examination Adds to Outpatient Visits: A Study of Cross-Sectional Data.

Abstract

Background and objectives: The neurologic examination is a key part of neurologist visits. The neurologic examination leads to more accurate diagnoses, avoidance of unnecessary tests and procedures, and a stronger doctor-patient relationship. However, the neurologic examination takes time to perform, leading to longer visits with neurologists than with other specialists. We hypothesize that the neurologic examination adds quantifiable time to patient visits to a neurologist.

Methods: We examined a 5-year cross-section of the National Ambulatory Medical Care Survey, 2012-2016, selecting visits to a neurologist. We extracted an indicator for neurologic examination, time spent with the patient in minutes, patient demographics, new or established visit, reasons for visit, new vs chronic problems, insurance status, geographic region, collection year, and survey design variables. We report descriptive statistics among patient visits with and without neurologic examinations and built a generalized linear model of visit time and neurologic examination with patient and visit information as covariates and interaction terms between neurologic examination and new/established visits. A subgroup analysis was conducted by reasons for visit. All analyses incorporated survey design variables for accurate standard errors.

Results: There were 4,009 patient visits among 211 neurologists, comprising 11.3 million annual visits in the weighted sample. Neurologic examination was reported in 58%, with no difference in demographics, geographic regions, or reasons for visit between those who did or did not receive a neurologic examination. The mean time spent with the patient in visits with a neurologic examination was 29.9 minutes, compared with 25.0 minutes without (p = 0.002). In the adjusted model, new visits with a neurologic examination were associated with 4.1 minutes greater time spent with the patient (95% CI + 0.6 minutes, +7.7 minutes, p = 0.02) and established visits with a neurologic examination were 4.6 minutes longer (95% CI + 1.5 minutes, +7.5 minutes, p = 0.006.) In subgroup analysis, association of neurologic examination with time spent with the patient was greatest for visits for pain (+6.7 minutes, 95% CI + 0.7 minutes, +12.9 minutes, p = 0.03) and known neurologic diagnoses (+7.5 minutes, 95% CI + 4.2 minutes, +10.7 minutes, p < 0.001).

Discussion: This study demonstrates the association of neurologic examinations with increased time spent with the patient in ambulatory care. Further work is needed to assess the effects on medical decision making, costs of care, and patient access to neurologists.