Abstracts

Rationale: The Veterans Health Administration (VHA) established Epilepsy Centers of Excellence (ECoE) mandated by Public Law 110-S. 2162 in 2008. One of the missions of the ECOE is to obtain accurate estimates of disease frequency measures in the VHA for surveillance and distribution of resources. In order to meet the above objectives, ECoE initiated the process of tracking patients by developing algorithms for the identification of epilepsy patients using VHA administrative databases.Methods: Patients treated with an antiepileptic drug during FY13 and simultaneously diagnosed with seizures (ICD-09 CM 345.xx, 780.39) during FY11-FY13 were identified as FY13 epilepsy patients. Seizure documentation on the inpatient or outpatient encounters was considered excluding data from EEG and/or Long term video EEG monitoring clinics to reduce the inclusion of false positives. FY11-FY13 diagnosis data were considered for capture of chronic patients. Patients’ demographics including age, gender, Operation Enduring Freedom, Operation Iraqi Freedom, operation New Dawn (OEF/OIF/OND) status and primary station of care were also extracted.Results: A total of 81,438 Veterans were identified as epilepsy patients with an estimated prevalence of 14.0 per 1,000 VHA patients. The estimated prevalence per 1,000 patients among males was 14.3 and among females was 10.9. Among the OEF/OIF/OND Veterans the estimate of prevalence was 7.7 per 1,000. ECoE provided care to approximately 17% of epilepsy patients. Chart evaluation of 500 randomly selected patients from Southeast region (Durham, Miami, Gainesville and Tampa) by epilepsy experts showed an estimated positive predictive value of 82.0% (95% confidence interval 78.6% to 85.4%) of the used algorithm for the identification of epilepsy cohort.Conclusions: Prevalence estimates of epilepsy in the VHA are relatively elevated than those reported for civilian population of USA. Used algorithm had high accuracy for the identification of epilepsy patients. Continuous surveillance of epilepsy patients in the VHA will be helpful in determining the trends of epilepsy prevalence among VHA patients in general and OEF/OIF/OND Veterans in particular. In this regards, ECoE can play a pivotal role for the optimal specialty care of epilepsy patients in the VHA.