As a fledgling neurologist in the early 1990s, Mitchell Elkind, MD, had few treatment options to offer patients once he made a diagnosis. Nothing for dementia or stroke and just one drug for multiple sclerosis. Over the past few decades, new treatment options have emerged—giving rise to the need to track outcomes. “There’s a lot more available,” says Dr. Elkind, “so the question has become, ‘Which is the best treatment and what’s going to give the patient the best quality of life when you consider side effects and benefits and even the financial cost?’”
In October, in a joint effort with the Gertrude H. Sergievsky Center, the Department of Neurology formed a new research division to answer those questions. Dr. Elkind, professor of neurology in P&S and of epidemiology in the Mailman School of Public Health, is founding director of the Division of Clinical Outcomes Research and Population Sciences (Neuro CORPS), one of the nation’s first such divisions. Initially, Neuro CORPS will leverage resources already available at Columbia—through the Department of Neurology, the Sergievsky Center, the Department of Medicine, the Department of Biomedical Informatics, Mailman, Columbia Nursing, Columbia’s engineering school, and the Irving Institute for Clinical and Translational Research.
The timing could not be better, says Dr. Elkind. An aging population means a growing demand for optimized treatments as the incidence of stroke, dementia, and other neurological conditions increases. The Affordable Care Act has imposed requirements for proven, cost-effective treatment protocols and also created new opportunities for discovery through the widespread adoption of electronic medical records.
In September, Dr. Elkind, also a member of the stroke division in the Department of Neurology, submitted a proposal for funding the first Neuro CORPS investigation, to weigh the relative merits of inpatient and outpatient evaluation of patients with transient ischemic attacks and minor strokes. “At present, patients are managed in a variety of ways and settings, including outpatient, inpatient, and often during prolonged emergency department stays,” says Dr. Elkind, who seeks to test a protocol based on rapid assessment in an outpatient setting.
“Defining optimal evaluation and treatment for these patients, including risk stratification and referral to urgent outpatient specialty clinics, would have the benefits of preventing stroke, improving patient outcomes and satisfaction, reducing emergency department and hospital length of stay, optimizing resource utilization, and reducing costs.” An outpatient approach, Dr. Elkind notes, has the added benefit of enhanced compatibility with Medicare’s reimbursement regulations on the amount of time a patient may be held for observation without being formally admitted to the hospital and also would reduce the risk of hospital-acquired infections.
Other topics of investigation for Neuro CORPS will include health services research and emerging approaches such as social network analysis, agent-based modeling, and decision analysis. In addition to bringing together scholars throughout the Department of Neurology for weekly conferences to focus on outcomes research, the division expects to hire three new faculty members. With one search already under way, Dr. Elkind expects to announce the first hire in the spring. “There are a lot of methodological changes going on in research, at the same time that the health care climate is changing,” he says. “We want to be at the forefront of the science of outcomes research.”