INTRODUCTION Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. METHODS We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. RESULTS We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). DISCUSSION In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.

中文翻译：

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学术医疗中心头痛电子咨询项目的医疗保健利用影响。

简介 跨专业咨询（“eConsults”）可以减少医疗保健利用率。然而，电子咨询对头痛患者的医疗保健利用的影响仍然知之甚少。方法 我们进行了一项回顾性 1:1 匹配队列研究，比较通过电子咨询请求或在纽约西奈山卫生系统亲自转诊评估头痛的患者。各组在临床和人口统计学特征上进行匹配。我们的主要结局是转诊日期后 6 个月内发生一次或多次门诊头痛相关事件。次要结局包括同一时期内一次或多次全因门诊神经科和头痛相关的急诊科 (ED) 就诊。我们使用单变量和多变量逻辑回归来模拟自变量和结果之间的关联。结果 我们确定了 74 名头痛电子咨询患者，他们与 74 名亲自转诊的患者相匹配。与对照组患者相比，电子咨询组患者实现主要结局的可能性较低（29.7% vs 62.2%，P < 0.0001），或出现全因门诊神经科就诊的可能性（33.8% vs 79.7%，P < 0.0001） 。两组在与头痛相关的 ED 遭遇方面没有显着差异。在多变量分析中，eConsult 组患者出现一次或多次头痛相关或全因神经科就诊的几率明显低于对照组患者（比值比 (OR) 0.3，95% 置信区间 (CI) 0.1- 0.6；OR 0.1，95% CI 0.1-0.3）。讨论 与亲自转诊相比，头痛的电子咨询请求与短期内神经科门诊就诊的可能性降低相关，但与头痛相关急诊就诊的差异化使用无关。更大规模的前瞻性研究应该验证我们的研究结果并评估患者的治疗结果。