Authors :
Presenting Author: Dennis Obat, MD – University of California, San Francisco
Elaine Kiriakopoulos, MD MPH MSc – Dartmouth Health
Sarah Kaden, BA – Dartmouth Health
Laura De Muro, MA – Dartmouth Health
Chelsea Yuen, n/a – University of California, San Francisco
Jonathan Kleen, MD, PhD – University of California, San Francisco
Rationale:
The HOBSCOTCH (Home-Based Self-management and Cognitive Training Changes Lives) evidence-based telehealth deliverable epilepsy self-management (ESM) program has demonstrated patient benefits in quality of life and cognition. Despite evidence, ESM programs have met challenges in their translation to real-world clinical settings. Two key barriers to HOBSCOTCH access via epilepsy centers include clinician awareness of program availability and challenges in patient follow through to enrollment post-referral, often secondary to memory impairment. To grow capacity for ESM implementation, the HOBSCOTCH Institute Translational Network (HITN; Dartmouth Health), a Hub and Spoke network of 18 U.S. epilepsy centers, was established in 2023. The University of California, San Francisco (UCSF) is a designated HITN spoke site. This study evaluates access and referral outcomes of ESM implementation at UCSF.
Methods: In Year 1 of HITN, UCSF clinicians received HOBSCOTCH program education and were encouraged to discuss with patients and follow through to referral using a HIPAA compliant link or via website form. Referred patients are screened by a HOBSCOTCH Institute (HI) coordinator and matched with a HI hub Cognitive Coach for program delivery. At the beginning of Year 2, quality improvement (QI) strategies co-developed with the HI hub aimed to increase provider referral and patient access to ESM. The pillars of UCSF approach: 1) reminders/updates at monthly faculty meetings, 2) partnering with UCSF neuropsychologists who implemented an opt-out patient education framework, 3) monthly “referral sweep” inventory by an attending-resident team revisiting all known referrals and their stages, 4) direct outreach by a neurology resident for step-by-step assistance enrolling on the HI website, and 5) quarterly meetings with HI hub to review progress and QI efforts, and share bidirectional feedback
Results:
In Year 1 of HITN, there were 18 referrals from 6 UCSF providers; 16 patients followed through to a screening call with a program coordinator and 13 chose to enroll and were connected with HOBSCOTCH Coach; of these 10 participants completed all eight sessions of the program. Comparatively in HITN Year 2, eight months into QI strategy implementation, there were 41 referrals (2.3 fold increase in referrals) from 13 UCSF providers (2 fold increase in engaged providers) of which 38 patients had completed a screening call, 30 had chosen to fully enroll, 16 had completed the program and 14 were actively engaged in HOBSCOTCH sessions with a Coach. At the current rate of increase in referrals (over 5/month) there was a projected Year 2 (12-month) total of 61 referrals, a 3.4 fold increase.
Conclusions: Contextual implementation strategies and QI efforts guided by an invested site Champion and supported by infrastructure available at the HI hub are proving key to building capacity for ESM support. Cornerstones of QI at UCSF highlighted education, communication, neuropsychology integration, referral “sweep” strategies, regular epilepsy team updates and direct physician-to-patient outreach
Funding:
Funding Source: Centers for Disease Control and Prevention 1NU58DP007541-01-00