Transforming Patient Care in Neurology – Clinical Advances and New Programs at UPMC Provide Increased Patient Access

The global shortage of neurologists has become increasingly acute, with a widening gap between the demand for specialized neurological care and the available supply of trained professionals. This challenge is compounded by the aging population and a rise in the prevalence of neurological disorders requiring specialized, long-term care. This shortage of trained neurology providers necessitates inventive approaches to care delivery, ensuring patients receive timely and effective treatment. In response, the UPMC Department of Neurology has pioneered a number of innovative solutions to enhance access to care and improve patient outcomes in both the inpatient and outpatient care domains.

"When COVID-19 occurred, it precipitated a dramatic shift in the landscape of health care, propelling telemedicine to the forefront of our service delivery models. This evolution has not only facilitated an expansion of our capabilities beyond the confines of traditional settings but has also fostered a mutually beneficial dynamic for patients, providers, and the organization at large. By transcending geographical limitations and minimizing disruptions to daily life, telemedicine has redefined the parameters of accessible and efficient care," says Alexandra Urban, MD, Vice Chair for Clinical Affairs & Associate Professor, Department of Neurology; Epilepsy Fellowship Program Director at the University of Pittsburgh School of Medicine and UPMC.

However, as Dr. Urban explains, while telemedicine has and will continue to bridge the gap in access to specialized neurologic care, other options and clinical care program innovations must continue to be developed. Telemedicine cannot necessarily be the only solution.

Outpatient Care Solutions for Increased Access – Strategic Use of APPs, Rapid Access, and Teleneurology

The UPMC Department of Neurology has employed a comprehensive strategy to enhance outpatient care access through a variety of clinical programs for patients and training new providers to expand clinical care options. These include a greater emphasis on training and deploying specialized neurology Advanced Practice Providers (APPs), the creation of the Rapid Access in Neurology (RAN) Program, and innovative applications of teleneurology services.

“These initiatives are designed to bridge the growing gap in access to neurological care, leveraging technology and specialized training to improve service delivery and patient outcomes,” says Dr. Urban.

Advanced Practice Provider Fellowship

In late 2022, the UPMC Department of Neurology introduced a 1-year APP Fellowship and APP Transition to Practice Program in neurology, aimed at equipping APPs with specialized skills for conducting initial assessments and essential investigations. These programs represent a strategic move to integrate APPs into the neurology care continuum as one means of addressing the provider shortage. The program is directed by Ryan Orie, PA-C, along with program co-directors Emily Guerriero, PA-C, and Justin Lander, CRNP.

“This initiative serves as the entry point for APPs into roles that are crucial for enhancing the overall efficiency of health care systems within our department,” says Dr. Urban.

The Rapid Access in Neurology (RAN) Program

To address the need for improved outpatient access for new patients, UPMC implemented the RAN Program, a novel care model staffed by APPs. This program is currently operational at UPMC Presbyterian and UPMC Mercy, providing swift intake and evaluation for new patients.

The RAN program is designed to ensure timely assessment, initiate essential investigations, and incorporate an efficient triage system to direct patients to the appropriate subspecialist or external referral when required.

“Over seven months in 2023, the RAN Program significantly increased operational efficiency, facilitating more than 1,000 new patient appointments,” says Dr. Urban. “Additionally, the program has been able to reduce the lag time between appointment scheduling and actual consultations to less than two weeks, a particularly striking example of its success. The RAN program also has seen less than half of the traditional patient appointment no-show and late cancellation rate, approximately 10%, streamlining health care processes and enhancing patient engagement.”

The early successes of the RAN Program not only demonstrate the effectiveness of integrating APPs into the care continuum but also highlights the potential of telehealth in extending the reach and flexibility of the program.

When the RAN program was launched, it also included a teleneurology-specific component, leveraging the capabilities of two physicians to offer comprehensive outpatient care remotely. This component of the program has enabled the department to employ neurologists located far beyond the physical confines of UPMC, including the notable inclusion of a former trainee now residing in California.

“I think this arrangement benefits from the time zone differences where our providers are located, allowing for late evening appointments to patients,” says Dr. Urban. “It also has been one solution to the growing concern of provider burnout by maintaining routine daytime work hours for the neurologist.”

Building on this momentum, the RAN program has further expanded to include a dedicated telehealth service focusing on rapid hospital discharge follow-up. Operational across 10 UPMC hospitals, this innovative approach aims to minimize unplanned readmissions by ensuring that patients receive timely evaluations post-discharge.

“This initiative is important because it can address any misunderstandings or clarifies questions regarding a patient’s discharge plan,” says Dr. Urban. “Any means or method we can employ to prevent an avoidable readmission is a good thing.”

Through these expansions, the RAN program continues to exemplify both the transformative impact of telehealth and APP integration in improving health care, and the department’s commitment to exploring new modes of patient care.

Creating a Hybrid Telehealth Model

To extend high-quality, accessible neurological care to regional and rural communities, the UPMC Department of Neurology has implemented a hybrid-telehealth model in locations including UPMC Northwest, UPMC Horizon, and UPMC Jameson. This model combines in-person support from medical assistants or nursing staff with remote access to tele-neurology specialists, overcoming connectivity issues and ensuring comprehensive care for patients.

Additionally, the program includes specialized clinics for patients with Multiple Sclerosis, run by neuroimmunologists proficient in addressing complex cases in the Central Pennsylvania region.

“This approach brings sub-specialized care closer to patients' homes, reducing travel time and making high-level neurological care more accessible,” says Dr. Urban.

Local Community Clinic Partners

The UPMC Department of Neurology created an innovative program that allows academic-based physicians to hold clinic sessions in local communities, extending specialized care traditionally confined to the main UPMC academic campus in Pittsburgh to more accessible locations. Unlike conventional telehealth services, this initiative utilizes virtual technology primarily to support physicians' academic and administrative collaborations with the department, rather than for direct patient interactions. This strategic use of virtual meetings and conferences enables physicians to maintain their connections within the Department of Neurology while providing in-person care at local clinics full time. This model ensures that the expertise and specialized services of UPMC's physicians are more readily available to patients outside of Pittsburgh, without compromising the quality of care through direct, personal engagement.

“It’s another way of making sub-specialized neurological care accessible to wider communities,” says Dr. Urban.

Improving Inpatient Care Dynamics

Within the inpatient care realm, the UPMC Department of Neurology has created tele-neurohospitalist rounding during the last several years, introducing it as a novel care model. This strategic initiative has improved access to neurological services, particularly benefiting smaller and remote hospital locations by circumventing traditional barriers to specialist care in these setting.

“One of the key benefits of this approach,” explains Dr. Urban, “Has been a marked reduction in travel time for providers. It has expanded the number of daily consultations available, but also enables a single provider in the Department to effectively serve multiple hospitals with appropriate patient volumes.”

Looking ahead, in February 2024, the tele-neurohospitalist program is slated for expansion into a larger volume hospital that has faced challenges in securing a full-time neurohospitalist, relying instead on locum neurohospitalists.

“The integration of a dedicated TeleNeuroHospitalist in this setting is anticipated to enhance care continuity and provide a higher level of multidisciplinary care for patients,” says Dr. Urban. “This will be achieved by forging lasting connections between providers, improving the overall quality of inpatient neurological care as well as ongoing continuity with a patient’s other health care providers.

These clinical care advances deployed across the UPMC system and beyond by the Department of Neurology showcase its ongoing work to test, create, and deploy innovative care solutions to meet patient needs and patient volume levels, all of which are on track to continue growing.

"As I reflect on the progress and impact of our neurology initiatives to increase patient access and quality of care, I am convinced of their transformative power,” says Dr. Urban. “These programs are not merely adjustments but are fundamental changes to how we deliver care, changes that ensure our medical resources are utilized more efficiently and effectively to achieve higher levels of patient satisfaction, quality, and outcomes."

Patient Referrals and More Information

For neurology clinical case consultations and patient referrals, or to learn more about the innovative clinical care models in practice at UPMC discussed in this article, please contact 412-692-4920 or visit our website.