Abstracts

Rationale: Hospital care plays a significant role in the diagnosis and treatment of people with epilepsy (PWE) as first or unexpected severe breakthrough seizures are most likely to be evaluated at the nearest facility. The most advanced levels of epilepsy care, often conducted at level 3 or 4 epilepsy centers, are generally located in dense urban environments which limits access by rural communities. Epilepsy centers are thought to play a vital role in the accurate and early diagnosis of epilepsy, and are important when dealing with drug resistant epilepsy. Thus, it is valuable to discern the differences in epilepsy care provided across various types of hospital facilities through relative costs as well as resources utilized to evaluate patients with epilepsy. To assess this, a hospital-based retrospective study was conducted. Methods: To assess the differences in hospital care for PWE we stratified the facilities into three groups (epilepsy center, urban, and rural) and then examined differences using a state-wide multi-hospital database identifying 37,859 epilepsy and seizure cases from 2001, 2006, and 2011. Visualizations of the data were used to identify time trends and patterns in illness severity (as a four level categorical variable), length of stay, and rates of procedure codes. Rate of procedure codes were measured to quantify the procedures patients went through while hospitalized. Specific analyses of total charges were conducted via ANOVA models. Results: Between the 3 facility groups (epilepsy center, urban, and rural) there were significant differences (p < 0.001) in total charges across all 3 years, with epilepsy centers representing the highest cost of hospitalization, followed by urban, and then rural facilities. Illness severity was similar between urban and rural facilities with relatively identical breakdowns and trends across all four variables (high number of moderate cases, with equal numbers of minor and major cases and fewer extreme). Notably, epilepsy centers had less moderate severity cases, and an equal mix of minor, moderate, and major. Length of stay trends were similar across all three facility categories, with means and medians higher at epilepsy centers compared to urban and rural facilities. It was noted there was a slower disuse of CT scans with a slower uptake of EEG and video-EEG at rural facilities when compared to urban and epilepsy centers. Increasing rates of vEEG was seen in epilepsy centers for minor and extreme cases and a decrease for moderate and major.  Conclusions: The findings of this study demonstrate differences between epilepsy centers, urban, and rural facilities when it comes to the treatment and care of persons living with epilepsy. Significant differences in costs were observed, even though parallel differences were not seen in illness severity, length of stay, or general cost differences between urban and rural environments. Overall, these differences highlight variation in care availability and practices between epilepsy centers, urban, and rural facilities alluding to potential disparities in patient outcomes. Funding: This work was supported by the Intramural Research Program of the National Institute of Neurological Disorders and Stroke, National Institutes of Health.