Originally dated 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)