Effects of Fragmentation and the Case for Greater Cohesion in Neurologic Care Delivery.

GOALS:To define fragmentation in neurologic care delivery, explain the positive and negative drivers in neurologic practice that contribute to fragmentation, illustrate situations that increase fragmentation risk, emphasize the costs and impact on both patients and providers, and propose solutions that allow for more cohesive care. WORK GROUP:The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice. METHODS:Research material included AAN databases, PubMed searches, discussion with topic experts, and AAN leadership. RESULTS:Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care, and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine. LIMITATIONS:This article shares our opinions as there is a lack of evidence-based guidelines for optimal neurologic care delivery.