The VA EEG Utilization Project: A National VA Operations and Quality Improvement Initiative
Abstract number :
1.392
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2204342
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Marissa Kellogg, MD, MPH – Portland VA Medical Center / OHSU; Connor Smith, MS – Oregon Health & Science University; Mary Jo Pugh, PhD, RN, MPH – Salt Lake City VA / University of Utah; Zulfi Haneef, MD – Houston VA / Baylor University School of Medicine; Rizwana Rehman, PhD – Durham VAMC; Jack Jones, MD – Madison VA / University of Wisconsin; David McCarthy, MD – Boston VA; Alan Towne, MD, MPH – Richmond VA; Glenn Graham, MD, PhD – VA Neurology Central Office / UCSF; Sharyl Martini, MD, PhD – VA Neurology Central Office / Baylor College of Medicine; Eilis Boudreau, MD, PhD – Portland VA / OHSU
Rationale: The overarching goal of the VA EEG Utilization Project is to improve Veterans’ access to comprehensive epilepsy and seizure care services through data-driven strategic planning and expansion of telehealth and tele-EEG services. The national Epilepsy Centers of Excellence (ECoE) were founded in 2009 and received dedicated federal funding (Public Law S. 2162) to improve the health and well-being of Veterans with seizure disorders through the integration of clinical care, research, and education. Funding for the ECoE remained relatively static (~$6 million) from inception until 2021 when inclusion in the Presidential Budget increased ECoE funding to $10M to expand seizure telehealth and tele-EEG. This abstract outlines a preliminary analysis of long-term VA EEG utilization and is designed to help with future initiatives to improve EEG access and optimize resource utilization.
Methods: A 20-year retrospective cohort study including all U.S. Veterans who underwent greater than 12 hours of continuous EEG (cEEG) or ambulatory EEG (aEEG) monitoring within VHA from 2002 through 2021. Inclusion criteria: all completed encounters coded for 12+-hour EEG with video CPT codes (95951, 95720, 95722, 95724, and 95726) and without video CPT codes (95950, 95953, 95956, 95827, 95719, 95721, 95723, 95725). Study location (inpatient vs outpatient) was then determined. Data were obtained from the VA Corporate Data Warehouse (CDW) via the VA Informatics and Computing Infrastructure (VINCI) and analyzed with SQL and R.
Results: The number of Veterans monitored by cEEG or aEEG at the VA more than doubled within 3 years of the establishment and funding of the national ECoE in 2009 (Figure 1). Despite a static federal budget, EEG volume continued to rise steadily until 2016 when numbers plateaued. There was a >50% reduction in EEG volume from 2019 to 2020 presumed due to COVID pandemic-related EEG lab and EMU closures. Over the last 20 years, the percentage of inpatient cEEG performed with video increased from 30%-50% to >95% of unique patient studies, while the outpatient aEEG with video increased from 20%-30% to 50%-60% (Figure 2).
Conclusions: Dedicated federal funding for Veterans with epilepsy more than doubled Veterans’ access to EEG services from 2009 to 2011. After 15 years of relatively static funding, the 2021 Presidential Budget significantly increased ECoE funding to facilitate further expansion of VA seizure telehealth and tele-EEG. The next phase of this initiative will examine patient outcomes associated with this increased access and will compare VA-based care with VA-purchased community care.
Funding: This material is the result of operations/quality improvement work supported with resources and use of facilities at the VA Portland Medical Center, ECoE, VA Office for Rural Health Sleep Telemedicine Program, and VA Neurology Central Office.
Health Services (Delivery of Care, Access to Care, Health Care Models)