Healthcare Utilization and Cost Outcomes for a Multicenter First Seizure and New Onset Epilepsy Clinic
Abstract number :
2.398
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2018
Submission ID :
500686
Source :
www.aesnet.org
Presentation date :
12/2/2018 4:04:48 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Emily R. Hudson, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Northwest; Evan J. Fertig, Providence Brain and Spine Institute; Alexandra Lesko, Providence Brain and Spine Institute; Lindsay Lucas, Providence Brain
Rationale: A First Seizure/New Onset Epilepsy (FS/NOE) protocol was implemented to ensure proper evaluation by an epileptologist and improve overall care for patients. We compared healthcare utilization and cost incurred by patients pre and post protocol implementation. Methods: The pre-implementation cohort included patients seen in the emergency room (ER), neurology, or primary care clinic with a first seizure from January 2014-December 2015. The post-implementation cohort included those enrolled in the FS/NOE protocol from March 2016-January 2018. Utilization outcomes included studies completed, ER visits and hospital length of stay (LOS). Cost outcomes included annualized median costs for ER, inpatient, outpatient diagnostic, ambulatory and total costs. Outcomes were further characterized as overall and seizure-related only. Pre and post cohorts were compared using Wilcoxon rank sum tests for costs, negative binomial regression for number of visits and length of stay, and chi-squared tests for percentage of patients with imaging and EEG studies. Cohorts were matched on follow-up time. Results: A total of 134 patients were included, 67 in each cohort. More post cohort patients had EEGs (93% vs. 40%; p<0.001) and MRIs (73% vs. 36%; p<0.001), but less had CTs (63% vs. 84%; p=0.011). For the post cohort, overall ER visits were reduced (1.40 vs. 2.24, p=0.021), but not seizure-related ER visits (0 .95 vs. 0.72, p=0.181). Both overall and seizure-related LOS was lower in the post group (0.98 vs. 1.69, p=0.014) and (0.18 vs. 0.45, p=0.009), respectively. Post cohort patients had increased overall total (+$1,383, p=0.012), outpatient diagnostic (+$749, p<.001) and ambulatory (+$1,460, p<.001) costs, but had lower overall ED costs (-$547, p=0.027). Additionally, they had increased seizure-related total (+$1,547, p<.001), ambulatory (+$1046, p<.001) and outpatient diagnostic (+$524, p<.001) costs. Conclusions: Implementation of a FS/NOE protocol results in improved quality of care with more obtaining EEG and MRI studies, reduced ER visits, and shorter hospitalization. However increased ambulatory and outpatient diagnostic costs outweighed cost savings associated with fewer ER visits and shorter inpatient LOS, albeit in the short-term. Future analysis will examine the long-term impact of the protocol. Funding: None