Abstracts

Rationale: The purpose of this study was to identify hospital characteristic factors affecting Total Charges (TCS) by patients with epilepsy (PWE). The principal objective was to analyze the effect of patient, hospital and geographic characteristics on Total Charges by PWE. We used the revised theoretical model of healthcare access and utilization, the Andersen Behavioral Model.Methods: This study used information on hospital discharges of PWE extracted from the 2004 Healthcare Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). To extract the epilepsy population we used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. To explain the variability of TCS, we have used Gamma Distribution Regression Analysis. Regression models incorporated the predisposing factors (age, gender), enabling factors (patient characteristics: admission source, payer information, median household income; hospital characteristics: control/ownership, geographic region, teaching status, location, bed size), and illness/need factors (admission type, number of medical diagnoses, number of medical procedures and severity measures) to identify how these variables influence the TCS for PWE admitted to hospitals within the sampling frame. Results: The data set for the analysis totaled 261, 024 weighted hospital discharges of patients with a primary diagnosis of epilepsy. Mean TCS for the sample was $15,4445.00 and ranged $33.00 to $852,101.00 with SD of $23,909.00. Hospital characteristic factors that significantly affected TCS: Private, Investor Owned/Private Collapsed and the Government or Private Collapsed categories of hospital discharges reported having had higher TCS than hospital discharges from the Government, Non-Federal Public category, (Odds Ratio (OR): 1.416, [95% confidence interval (CI) 1.354 - 1.480]), and (OR: 1.126, [95% CI 1.071 - 1.184]). Discharges from the Rural hospitals reported somewhat lower TCS than Urban hospitals, (OR: .637, [95% CI .616 - .658]), p < 0.0001. Discharges in the Midwest, South and West Regions reported lower TCS than the Northeast region, (OR: .730, [95% CI .711 - .749]), (OR: .879, [95% CI .855 - .903]), and (OR: .956, [95% CI .919 - .996]), respectively. Small and Medium bed sized hospitals reported lower TCS than the large category bed size hospitals, (OR: .793, [95% CI .772 - 0.815]) and (OR: .870, [95% CI 0.852 - 0.888]), respectively and at p < 0.0001.Conclusions: Non-Federal Public hospitals showed significantly lower Total Charges. Patients with epilepsy in the Northeast region utilizing large bed sized hospitals, which tended to be located in urban areas, reported higher Total Charges. Access to care may be an issue for PWE with limited insurance as some services may prove to be costly. Policy implications may include customizing outreach programs to PWE who may be in need of epilepsy-related hospital services.