Abstracts

Rationale: Adolescents and young adults (AYAs) with epilepsy may need to transition from pediatric to adult healthcare settings. Unfortunately, transition is a vulnerable period that can lead to discontinuity of care, decreased quality of life, treatment non-adherence, and excess morbidity. Established guidelines for successful healthcare transition exist; however, no studies have examined the burden of healthcare transition in epilepsy via healthcare utilization. Therefore, in line with the IOM (Rec 6) and NINDS Benchmarks (IV) an important next step is to assess utilization of epilepsy healthcare services, particularly for underserved rural populations, in order to improve care for AYAs with epilepsy. The current study evaluated healthcare utilization (time to first adult visit, ED visits, hospitalizations) related to epilepsy healthcare transition in rural North Carolina. We compared healthcare utilization one year before and one year after transition.

Methods: Patients identified via medical record data had epilepsy and were 15-30 years old seen by outpatient neurology providers between 2015-2018 (at least one pediatric and one adult visit). Transition in this practice includes transfer from a pediatric to adult neurologist’s schedule (i.e., both pediatric and adult clinics share location and some office staff). Exclusion criteria include surgery during the 1 year before or after transition due to the conceptualization that this is not a typical transition-related healthcare procedure or expense. Patients who received epilepsy surgery prior to the one-year pre-transfer date were not excluded from the study. Four healthcare utilization variables were collected, including: 1) days from last pediatric outpatient epilepsy visit to first adult outpatient epilepsy visit, 2) number of outpatient epilepsy clinic visits (pediatric and adult), 3) number of separate emergency department visits related to epilepsy, and 4) number of separate inpatient hospitalizations related to epilepsy. See Figure 1.

Results: Electronic medical record pull revealed 199,485 total healthcare encounters, which were refined to 1,685 total potential participants. After review of eligibility criteria, 78 total participants (M_age=19.6+2.5; 50.6% White Non-Hispanic, 55.1% male) with epilepsy were included. Utilization data from the electronic medical record is currently underway (completion 7/2021). We will compare utilization counts pre- and post-transition on the four utilization variables for presentation. (See Figure 1).

Conclusions: This project will advance epilepsy research and care by identifying the healthcare burden to patients and the healthcare system associated with healthcare transition in epilepsy. Future research will focus on identifying populations most at risk for poor transition outcomes, high healthcare usage and related expenditures, as well as developing cost-effective treatments to promote transition and better serve rural epilepsy patients.

Funding: Please list any funding that was received in support of this abstract.: This work was supported by the American Epilepsy Society through the Junior Investigator Award awarded to Aimee W. Smith.