Abstracts

Rationale: Epilepsy is one of the most common disorders of the brain, which accounts for 1% of the global burden of disease, equivalent to breast cancer in women and lung cancer in men. About 70% of epilepsies begin in childhood, contributing to lifelong impact on survival, cognitive development, and quality-of-life. However, according to the available data and future projections, the Child Neurology Society reported a national shortage of child neurologists in USA, with this deficiency being more marked for pediatric epilepsy specialists. Hence, there is a need to empower community providers for better management, and timely and appropriate referral of children with seizures and epilepsy. To achieve this, a telehealth-based project Extension for Community Healthcare Outcomes (ECHO)TM was implemented at Cincinnati Children's Hospital Medical Center (CCHMC). This model, initially used successfully for dissemination of hepatitis management, has been implemented across the globe for democratization of specialized knowledge for improving clinical care. Methods: Community pediatric practices (one clinician/practice) were recruited through direct contact and media dissemination, primarily targeting service area for CCHMC. These providers participated in monthly audiovisual sessions (total nine sessions), lasting 1 hour, and consisting of didactic teaching, interactive case discussion, and opportunity to discuss relevant clinical issues with other provider and the epilepsy specialist. The didactic curriculum included a comprehensive overview of pediatric epilepsy, with a focus on aspects pertinent to community pediatricians. In addition to a pediatric epilepsy specialist, some of the didactic sessions were led by clinical pharmacist, psychologist, dietician, and social worker, all from CCHMC Comprehensive Epilepsy Center. The cases included de-identified patients, seen in respective community practices that the participating provider felt represented a clinical challenge where the patient care patient will potentially improve from discussion with the epilepsy specialist. All participants were encouraged to form diagnostic and therapeutic hypotheses about the patient being discussed, and in the end, clear recommendations for future management were provided. Outcomes of project ECHOTM included increase in provider knowledge measured using pre- and post-test questions (Tables 1, 2) and improved referral patterns to epilepsy clinic measures by increased ratio of epilepsy/non-epilepsy patients. Results: Fourteen providers were recruited, primarily from tristate area (OH-KY-IN), however, including an epilepsy fellow from Australia! The providers include MDs (11), APNs (1), and RNs (2). The program went live in January 2019, and at present, five sessions have been successfully completed. The pre-test responses are summarized in Table 1. In response to survey questions, rated on a 1-7 Likert scale, where 7 represented “strongly agree,” 90% of the participants rated all sessions as ≥6 as a “worthwhile investment of their time.” The free text responses reveal useful learning for community pediatricians on multiple aspects of pediatric epilepsy management. Conclusions: We have demonstrated one of the first successful implementation of a pediatric epilepsy ECHOTM program using telehealth platform. By the time we present this poster, we will be able to analyze post-test data and additional outcome data. Funding: Maxon Foundation.