Authors :
Presenting Author: Hunter Rice, BS – Massachusetts General Hospital
Marta Bento Fernandes, PhD – Neurology – Massachusetts General Hospital, Harvard Medical School; Clio Rubinos, MD, MS – University of North Carolina, Chapel Hill; Adithya Sivaraju, MD, MHA – Yale New Haven Hospital, Yale University; Vineet Punia, MD, MS – Epilepsy Center, Cleveland Clinic; Neishay Ayub, MD – Rhode Island Hospital, Brown University; Sahar Zafar, MD, MS – Massachusetts General Hospital, Harvard Medical School
Rationale:
Post-hospitalization outpatient follow-up visits are crucial for preventing long-term complications, maintaining appropriate medications, and ensuring continuity of care. With increasing use of in-patient continuous EEG (cEEG) monitoring, more patients are diagnosed with epileptiform abnormalities (EA) including seizures and periodic and rhythmic patterns. Since little is known about these patients’ seizure recurrence or prognosis, they are often discharged on anti-seizure medications (ASMs). Many of these patients are also at risk for loss to follow-up. The goal of this study was to identify predictors of follow-up. This will ultimately guide development of quality improvement interventions for improving transitions of care for patients with acute symptomatic seizures and EA.
Methods:
This is a retrospective cohort study of all hospitalized patients (age
≥ 18 years) that underwent cEEG monitoring at a single center between 01/01/2016 to 12/31/2019. Patients were included if they were found to have EA. Clinical and demographic variables including race, diagnosis, and discharge disposition were recorded from health records. Follow-up status was determined through visit records during a six month window from discharge. Follow-up visits were stratified into all outpatient clinics and neurology outpatient clinics.
We performed a Lasso feature selection analysis for each follow-up type.Results:
A total of 723 patients (53% female, mean (std) age of 62.3 (16.4) years) were identified from cEEG records with 570 (79%) surviving to discharge. Of those discharged, 316 (55%) had a neurology follow-up, and 450 (79%) had any outpatient follow-up. 288 (51%) were readmitted during the six month period. Modeling showed that patients were more likely to have neurology follow-ups if they had shorter lengths of stay; were discharge to home-health care service or rehab facility, were younger, primarily cared for by the neurosurgery service or seen in multiple departments, received longer EEG monitoring, lived in nearby counties, and were white. Patients most likely to have outpatient follow-ups were discharged to a facility (e.g., rehab) or with home health services, were younger, lived in nearby counties, and were white.
Conclusions: Variables such as age, length of stay, discharge disposition, race, and accessibility (address) are among predictors of follow up. This data helps identify patient subgroups at highest risk for loss to follow-up and guide development of targeted interventions to improve their transitional care plans.
Funding: This work was supported by grant NIHK23NS114201.