Abstracts

Rationale: A patient-centered mobile health (mHealth)-intensive population health management (PHM) delivery model has been established in rural Northeastern Illinois for chronic epilepsy care. Up to 70% of these patients experience co-occurring mood disorders. 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. Nearly 70% of this group will require mental health access to social services. While about 20% of Americans live in rural areas about 9% of the nation's physicians practice in these areas. The community-based Northeastern mHealth-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 resources, and (3) an independent community-based PHM oordination hub facilitating the above components. Mood disorders screening tools for depression (NIDDI-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 1 year. Results: 'On-demand' community psychosocial resources were matched with all patients using the rural community PHM EHR and the patient cohort followed at RUMC. Three mood assessment tools (NIDDI-E, GAD-7, CDI for children only) were used. A 2-fold increase in clinically signficant 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-faciliated EMU admissions accounted for about 20% of all admissions to the EMU. Conclusions: The mHealth-PHM 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 an underserved geographic region. Preliminary data suggest that co-occurring clinically signficant 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 NIDDI-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. Vigilant rural community-based coordination monitoring is crucial for maintaining patient access to community resources and remote medical specialty expertise. Funding: Mental Health Board of McHenry County IL, Illinois Children's Healthcare Foundation, Upsher-Smith Pharmaceuticals, LivaNova