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The evaluation of distal symmetric polyneuropathy: utilisation and expenditures by community neurologists
  1. Brian C Callaghan1,
  2. Kevin A Kerber1,
  3. Mousumi Banerjee1,
  4. Eva L Feldman1,
  5. Lewis B Morgenstern1,
  6. Ruth Longoria1,
  7. Ann Rodgers1,
  8. Paxton Longwell2,
  9. Lynda D Lisabeth1
  1. 1Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Corpus Christi Neurology, Corpus Christi, Texas, USA
  1. Correspondence to Dr Brian C Callaghan, Department of Neurology, University of Michigan, 109 Zina Pitcher Place, 4021 BSRB, Ann Arbor, MI 48104, USA; bcallagh{at}

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Previous studies show that electrodiagnostic tests and MRIs are frequently ordered in the initial evaluation of neuropathy.1 ,2 However, American Academy of Neurology (AAN) guideline-supported tests, particularly the glucose tolerant test (GTT), are often omitted.1 Recent evidence suggests that electrodiagnostic studies and MRIs are the primary drivers of expenditures associated with neuropathy testing despite limited data to support their use.3 However, these results are based on Medicare claims; therefore, it remains unclear if this observation applies to other populations and when using a more rigorous case definition of neuropathy. Furthermore, Medicare claims do not provide detailed clinical information that would allow for investigation of patient-level factors associated with utilisation and expenditures.

Our aim was to determine utilisation and expenditures in the evaluation of a new diagnosis of distal symmetric polyneuropathy (DSP) by community neurologists using a population-based design and a strict case definition. We also sought to determine which patient and physician factors were associated with testing expenditures, electrodiagnostic and MRI utilisation.


We attempted to capture all new patients with DSP seen by community neurologists in Nueces County, Texas as previously described.4 Patients were required to meet the Toronto consensus panel definition of probable neuropathy and have a documented neuropathy diagnosis. From 1 April 2010 to 31 March 2011, we used a validated International Classification of Diseases 9 case capture technique to screen all new patient visits for cases followed by medical record abstraction to confirm that they met our DSP definition.5 The aetiology at the time of the initial visit to the neurologist was determined by the neurologist's documented …

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  • Contributors BCC was involved in study design and statistical analysis, and wrote the manuscript. KAK helped with study design, statistical interpretation, and contributed to the manuscript. MB helped with the statistical analysis plan and interpretation, and contributed to the manuscript. RL performed the screening and medical chart abstraction and participated in the study design. AR assisted in the statistical analysis. PL contributed to the manuscript. LBM, ELF, and LDL were involved in the planning of the project, interpretation of the statistical analysis and contributed to the manuscript. PL, Frank Bonikowski and J Felipe Santos helped coordinate this project at their respective sites.

  • Funding BCC was supported by a NIH T32 grant and an American Diabetes Association (ADA) Junior Faculty Award and is currently supported by NIH K23 NS079417. BCC and ELF are supported by the Katherine Rayner Program and the Taubman Medical Institute. KAK is supported by NIH/NCRR K23 RR024009 and AHRQ R18 HS017690. LBM is supported by the following NIH funding (significant): R01NS38916, R01NS062675, U01NS056975, U01NS062835, R18HS017690, R01NS073595, and R01HL098065. He also receives significant research support from St. Jude Medical. ELF is supported by NIH R24 DK082841-01 and NIH UO1 DK076160. LDL is supported by NIH/NINDS R01 NS38916, NIH/NINDS R01 NS062675, NIH/NHLBI R01 HL098065, and NIH/NINDS R01 NS070941.

  • Competing interests KAK received speaker honoraria from the American Academy of Neurology and Munson Medical Center, and served as a consultant for the American Academy of Neurology, and The Weinberg Group. KAK and LBM also provide expert medical legal work (modest) that does not involve industry.

  • Ethics approval University of Michigan IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.