Utilization and Cost Savings of Neuroscience Telemedicine Clinic for State Prison Inmates (P2.182)

Objective: Describe development/utilization of novel telemedicine-based neuroscience outpatient care in a state prison system. Background: In 2008, the maximal-security Utah State Prison sought to reduce costs and increase safety by limiting inmate transfers to the University of Utah Health Center (UUHC) clinics. They partnered with UUHC to implement multiple telemedicine clinics, including general neurology and neurosurgery. Telemedicine clinics are common-place for psychiatry but not described for neurosciences. Design/Methods: Clinics utilize telemedicine equipment at the prison and UUHC and are conducted by UUHC neurologists and neurosurgeons and a prison-based nurse trained in the neurologic exam. If additional subspecialty care is needed, inmates are seen in-person at UUHC. Prison staff retrospectively identified all inmate telemedicine visits from 6/2008–5/2016. We reviewed all their UUHC neurology and neurosurgery visits (telemedicine, in-person). Cost savings was determined based on $150 mean transport cost/inmate and telemedicine visit cost of $25/visit. Results: Over 98 months, the clinics served 558 inmates (92% male, mean age 43+/−12 years) in 1,108 telemedicine (352 in-person) visits. Of initial visits, 82% were telemedicine-based; 35% with neurology, 65% neurosurgery. Inmates had a mean of 2.0+/−1.6 telemedicine visits (range 1–10; 24% ≥3) and 0.6+/−1.2 in-person visits (range 0–9). Leading diagnostic categories for neurology were: neuromuscular (26%), movement (15%), headache (13%), epilepsy (12%), stroke (10%), dementia (5%), MS (4%); for neurosurgery: spinal disease (disc degeneration/herniation) (64%), spinal stenosis (14%), neuromuscular (9%). The total state prison savings for outpatient neuroscience care was $197,000 ($24,122/year). Physicians feel the telemedicine clinics may enhance care compared to in-person visits due to the presence of a knowledgeable prison-based nurse who conveys unique prescribing rules and has access to prison medical records (particularly useful for labs and patients with spells and dementia). Conclusions: General neurology/neurosurgical telemedicine-based clinics can serve the broad spectrum of neuroscience diseases present in the prison system, while minimizing costly and potentially dangerous transfers. Disclosure: Dr. Majersik, MD, MS has nothing to disclose. Dr. Fults, MD has nothing to disclose. Dr. diFrancesco, RN has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Chatwin, MPP has nothing to disclose. Dr. Hannon, MD has nothing to disclose. Dr. Tkach, MD has nothing to disclose. Dr. Shuman III, RN has nothing to disclose. Dr. Bernam, MD has nothing to disclose. Dr. Garden, MD has nothing to disclose.