Congratulations to Drs. Okun, Ramirez-Zamora, and Foote on the publication of “Neuromedicine Service and Science Hub Model,” in the January 2, 2018 issue of JAMA Neurology.
The US health care system is founded on a primary care gatekeeper model, in which patients are encouraged to select a primary care physician for routine health care delivery.1 When a medical problem exceeds the expertise or scope of practice of the primary care physician, optimal management requires consultation with an appropriate specialist. However, the delivery of specialized care for complex disorders in the United States tends to be expensive, inefficient, and less effective than it should be because of important weaknesses in prevalent specialty care practices. We describe an interdisciplinary service and science hub specialty care model implemented since 2011 at the University of Florida Center for Movement Disorders and Neurorestoration. It addresses common weaknesses in communication, preventive care, efficiency, outcome tracking, and optimization of individual and global patient care for Parkinson disease and other complex chronic neurologic disorders. Since opening in 2011, the University of Florida hub has increased use of multidisciplinary care by 92%, research enrollment by 19.5%, and deep brain stimulation surgical procedures by 18.9%.