Using a Scorecard to Track Neurological Care Disparities Related to Clinical Decision-Making: A Proof of Concept and Call to Action

Roshni Dhoot; Deborah Rose; Shakthi Unnithan; Danelvis Paredes; Meenakshi Roy; Charles H Roark; Petra Brayo; Hussein Al-Khalidi; Andrew R Spector

doi:10.7759/cureus.92781

Using a Scorecard to Track Neurological Care Disparities Related to Clinical Decision-Making: A Proof of Concept and Call to Action

Cureus. 2025 Sep 20;17(9):e92781. doi: 10.7759/cureus.92781. eCollection 2025 Sep.

Authors

Roshni Dhoot¹, Deborah Rose², Shakthi Unnithan³, Danelvis Paredes⁴, Meenakshi Roy⁵, Charles H Roark⁶, Petra Brayo⁷, Hussein Al-Khalidi³, Andrew R Spector¹

Affiliations

¹ Neurology, Duke University Medical Center, Durham, USA.
² Neurology, Johns Hopkins Health System, Baltimore, USA.
³ Biostatistics, Duke University Medical Center, Durham, USA.
⁴ Neurology, Northeast Georgia Medical Center Gainsville, Gainsville, USA.
⁵ Neurology, Rush University Medical Center, Chicago, USA.
⁶ Neurology, Parkridge Health System, Chattanooga, USA.
⁷ Neurology, Temple University Hospital, Philadelphia, USA.

Abstract

Introduction Health disparities result from a complex interplay of factors, with social determinants of health and inequities in healthcare delivery playing central roles. Among these, clinicians have a significant influence on rectifying healthcare-related causes. However, many clinicians remain unaware of their potential contributions to these disparities because individual clinical practices are seldom scrutinized to identify departmental or practitioner-level disparities. This study presents a model developed by an academic neurology department to systematically track and address disparities in clinical care, offering a replicable approach for other departments. Methods To develop a scorecard, eight clinical divisions were selected, each with one binary clinical decision point analyzed. The percentage of patients who received the designated intervention was stratified by race/ethnicity to identify any disparities in care. The presence or absence of a racial disparity in the care provided was translated into a scorecard for easy communication of results. The percentage of patients who received the designated intervention was stratified by race and ethnicity to identify any disparities in care. Findings were translated into a scorecard format, assigning grades based on the presence or absence of statistically significant disparities. Results The department's scorecard contained five As and two Bs (and one division with inadequate data) based on disparities of care identified in two divisions, stroke and epilepsy. The department's scorecard revealed that five divisions received an "A" rating, indicating no significant racial or ethnic disparities. One division had insufficient data for grading. Conclusion Scorecards are a practical tool for identifying and addressing disparities in clinical care. This information can facilitate transparency, promote targeted practice improvements, and strengthen trust with patients and communities. By adopting scorecards, institutions can enhance equity in care delivery and build credibility through accountability.

Keywords: disparities; ethnicity; implicit bias; race; scorecard.