美国境内各地区神经科医生的密度存在很大差异。我们的目标是测量神经疾病和亚专科就诊时患者的出行距离和时间。我们的次要目标是确定与神经疾病护理中远距离出行相关的因素。我们使用2018年的医保样本对至少有一次门诊神经科医生就诊的患者进行了横断面分析。将行驶距离≥50英里的就诊定义为远距离出行。旅行时间以分钟为单位进行测量。采用具有逻辑链接函数的多级广义线性混合模型，考虑了患者在医院转诊区域（HRR）内的聚类，允许建立区域特定随机效应的模型,以确定患者和区域特征与远距离出行之间的关联。我们确定了2018年有神经科医生就诊记录的563,216名医保受益者。其中96,213人（17％）为了治疗而进行了远距离出行。与没有长途旅行的患者相比，远距离出行的患者的中位行驶距离和时间分别为81.3（IQR: 59.9-144.2）英里和90（IQR: 69-149）分钟，而没有远距离出行的患者的中位行驶距离和时间分别为13.2（IQR: 6.5-23）英里和22（IQR: 14-33）分钟。在对比不同神经疾病时，神经系统癌症护理（39.6％），肌萎缩性脊髓侧索硬化症（32.1％）和多发性硬化症（22.8％）是远距离出行最常见的疾病。与远距离出行相关的因素有很多，尤其是神经科医生密度低（第一五分位数：OR 3.04[95％CI: 2.41-3.83]与第五五分位数相比），农村地区（4.89[4.79-4.99]），远距离出行到初级护理医生就诊（3.6[3.51-3.69]），以及肌萎缩性脊髓侧索硬化症和神经系统癌症护理的就诊（3.41[3.14-3.69]和5.27[4.72-5.89]，分别）。近三分之一的患者绕过了最近的神经科医生20英里以上，7.3％的患者为了神经医学护理跨越了州界。结论：我们发现，在医保受益者中，约1/5看神经科医生的患者需要单程行驶≥50英里。旅行负担对于需要协调多学科护理的较低发病率神经疾病来说最为常见。低神经科医生密度和农村地区是远距离旅行的重要、可能可调节的预测因子，这表明需采取措施改善护理的可及性，如远程医疗或神经亚专科医生支持现地神经科医生。未来的工作应评估远距离旅行患者和非远距离旅行患者之间的临床结果差异。© 2023年美国神经学会。

The density of neurologists within a given geographic region varies greatly across the US. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care.We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least one outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles one-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region (HRR) and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel.We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of these, 96,213 (17%) traveled long-distance for care. Median driving distance and time were 81.3 (IQR:59.9-144.2) miles and 90 (IQR:69-149) minutes for patients with long-distance travel compared to 13.2 (IQR:6.5-23) miles and 22 (IQR:14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), ALS(32.1%) and MS(22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (1st quintile: OR 3.04[95%CI:2.41-3.83]vs. 5th quintile), rural setting (4.89[4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41[3.14-3.69] and 5.27[4.72-5.89], respectively). Nearly one third of patients bypassed the nearest neurologist by 20+ miles and 7.3% of patients crossed state lines for neurologist care CONCLUSIONS: We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles one-way for care and travel burden was most common for lower prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurological subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.© 2023 American Academy of Neurology.