Abstracts

Rationale: An innovative PHRAC initiative has been established in rural Northeastern Illinois for chronic epilepsy care. Nearly 70% of this group require mental health access at some level. These patients can be compared with U.S. demographics, where individuals with refractory epilepsy are more likely to have low socioeconomic status, to be illiterate or marginally literate, and to live in medically underserved rural communities. The community-based Northeastern population health management (PHM) model aims to reduce seizure- and mental health-related hospital admissions, while improving the co-morbidity patterns and healthcare-use behavior, the benchmark of a successful PHM strategy. The clinical implementation of this strategy hinges on the ability to coordinate timely matching of community psychosocial services, and specialized medical care with a remote urban-based tertiary care medical center (RUMC). Methods: The methodology combines the following 3 innovative components: (1) a HIPAA-compliant portable video-conferencing communication protocol for remote access to specialists at RUMC, and community-based healthcare providers, (2) a custom-designed web-based HIPAA-compliant electronic health record (EHR) for accessing and tracking patient medical data and community-based psychosocial resources, and, as importantly, (3) an independent community-based PHM coordination hub facilitating the above components. Mood disorders screening tools for depression (NDDI-E) and anxiety (GAD-7) for adults, and the Children's Depression Inventory (CDI) for children in the rural mHealth-PHM hub were compared with those seen in an urban-based setting (RUMC, Chicago IL). Lastly, patient admissions to the RUSH epilepsy monitoring unit (EMU) from both the PHM referral center, and RUMC-based referrals were tracked for 2 years. Results: On-demand' community psychosocial resources were matched with all patients using the rural community PHM EHR and the patient cohort followed at RUMC since 2014. Three mood assessment tools (NDDI-E, GAD-7, CDI for children only) were used. A 2-fold increase in clinically significant mood disorders were seen in patients followed at the rural PHM hub compared with urban-based patients followed at RUMC (p < 0.05). Those rural patients symptomatic on visit 2 were over 3-times that of the urban cohort. In addition, the PHM hub-facilitated EMU admissions accounted for about 20% of all admissions to the EMU. Conclusions: The geographic expansion of our PHRAC delivery model overcomes barriers, including cost, allowing coordinated care to be effectively implemented. The model expands the geographic reach of a distant tertiary care medical center to underserved rural communities. Our data suggest that co-occurring clinically significant mood disorders in rural patients with refractory epilepsy are twice that of a cohort followed at a large urban-based Level 4 comprehensive epilepsy center. The elevated NDDI-E and GAD-7 measures in adults, and CDI scores in children are consistent with diagnosed major and sub-syndromic mood disorders in this population. However, such scores remained significantly elevated in the rural PHM cohort compared with the urban group, despite close follow up and appropriate psychosocial referrals. The PHRAC model can be organized and deployed regionally and across U.S. rural communities. Expansion of such vigilant rural community-based coordination monitoring is crucial for maximizing cost-effective PHM for maintaining local access to community resources and remote medical specialty expertise. Funding: Mental Health Board of McHenry County IL, UCB, Illinois Children's Healthcare Foundation, Upsher-Smith Pharmaceuticals, Foglia Family Foundation