Abstracts

Rationale: The Providence Brain and Spine Institute implemented a First Seizure/New Onset Epilepsy (FS/NOE) clinic to improve patient experience, accuracy of seizure and epilepsy syndrome classification, and appropriateness of treatment in order to reduce subsequent seizures and unnecessary healthcare utilization. In this study, we evaluated the effectiveness of the FS/NOE clinic by comparing epilepsy-specific quality outcomes before and after implementation at two urban hospitals. Methods: Pre-implementation data included information from patients who were discharged with a seizure-related diagnosis from the emergency room or who visited a neurology or primary care clinic for FS or NOE from January 1, 2014 through December 31, 2015. Post-implementation data included patients enrolled in a FS/NOE protocol from the ER or PCP offices from March 2016 through February 2017. Outcomes of interest included (1) median number of days between FS and first neurology appointment and first EEG exam, (2) the percentage of patients who had a completed EEG, 3) the percentage of EEGs with epileptiform abnormalities, (4) the percentage of patients who had a completed MRI, (5) the percentage of patients with an imaging study with a potentially epileptogenic lesion among all patients and (6) the percentage of patients who were provided counseling services for epilepsy-specific safety issues, potential teratogenic risks of antiepileptic drugs (AED) in women of childbearing potential, and side effects of AEDs, when appropriate. Pre- and post- implementation outcomes were compared using Wilcoxon Rank Sum tests and chi-squared or Fisher’s exact tests, as appropriate. Percentages or medians and Interquartile ranges were reported. Results: Data from 154 patients, 95 pre- and 50 post-implementation, were included in this analyses. Overall, 46% (n=67) were females and 11% (n=16) were non-white. Post-implementation patients had significantly shorter FS-to-first neurology appointment time (median days [IQR] =4 [2, 9] (n=50) vs 13 [7, 26] (n=37); p < 0.001), shorter FS-to-first EEG time (median days [IQR] =2 [1, 4] (n=48) vs 18 [7, 29] (n=28); p < 0.001), more EEGs completed (96% (n=50) vs. 29% (n=95); p < 0.001) and more MRIs completed (58% (n=50) vs. 26% (n=95); p < 0.001). In addition, appropriate counseling was provided significantly more often about epilepsy safety (100% (n=50) vs. 52% (n=95); p < 0.001) and teratogenicity (100% (n=7) vs. 0% (n=48); p < 0.001). There was suggestive, but inconclusive evidence for more patients with a potentially epileptogenic lesion (18% (n=50) vs 7% (n=95); p=0.096). There were no statistically significant differences in the percentage of patients counseled on AED side effects or EEGs with epileptiform abnormalities. Conclusions: These preliminary results suggest that FS/NOE clinic significantly improves quality of care by expediting both diagnostic and clinical evaluation and counseling.  Enrollment continues with a plan to analyze the impact on diagnostic yield, ability to identify epilepsy syndrome and etiology, healthcare outcomes and utilization in a larger sample with extended follow up. Funding: Portland InterHospital Physicians Association funding