Authors :
Presenting Author: Nan Lin, MD – CCHMC
Julianne Grimm, BSN, CPN – CCHMC
Lisa Clifford, PhD – CCHMC
Elizabeth Strasfeld, OTR/L – CCHMC
Kelly Kremer, MD – Cincinnati Children's Hospital Medical Center
Kris Wesselkamper, MD – CCHMC
Marissa Vawter-Lee, MD – CCHMC
Rosalyn Brown-Beatty, PhD – PRIVATE
Barbara Hallinan, MD, PhD – CCHMC
Joseph Bruce, MSW – CCHMC
David Ritter, MD, PhD – CCHMC
Scott Badzik, BS – CCHMC
Karen Leonard, BSN – CCHMC
Janet Majors, BSN, MBA – CCHMC
Katherine Holland-Bouley, MD, PhD – CCHMC
Rationale:
Socioeconomic determinants of health play a key role in the delivery of medical care to our patients with epilepsy and that disparities in care are present. Hospitals have traditionally used a multidisciplinary team in their efforts to provide equitable patient care across all demographic groups. We have expanded this concept to include not only case management, social work, nurses, physicians, patient family advocates and community engagement specialists but also other community-based supports including school-focused interventions, health-law partnerships with legal aid, and insurance-Medicaid case management systems.
Methods:
Data was collected both retrospectively and prospectively from a single-center large academic hospital on all epilepsy patients followed at this institution for their epilepsy care. These patients were 0-20 years of age with pre-existing diagnosis of epilepsy who sought care for breakthrough seizures through the emergency room (ER) or an urgent care (UC). ER/UC visits were used as a corollary for degree of seizure control.
Results:
Data generated from the medical record system was coded and retrieved based on ICD-diagnosis and encounter type along with the associated patient demographics. Between April 2023 and April 2025 there were 1752 combined ER/UC encounters across 747 unique patients. At our institution, we found higher rates of emergency room and urgent care utilization among black compared to non-black groups at nearly a twofold rate. Using quality-improvement methodology, multiple interventions were implemented using plan-do-study-act (PDSA) cycles (targeting, for instance, medication adherence) without any significant reduction in the rates of ER/UC utilization. Our patient family advocate then noted a seasonality related to school-related vacations and summer breaks (see Figure 1). Using geo-coding based on patient zip code (see Figure 2), we have formed partnerships centered around education and increased awareness of epilepsy with our public-school partners in the areas with the highest ER/UC utilization. Additionally, we are expanding access to health-law partnerships with legal aid and insurance-Medicaid case management systems to further reduce barriers to health care.
Conclusions:
Community-based interventions are feasible and essential to optimize care for all patients with epilepsy regardless of their demographic group. Longer term follow-up using this strategy is underway.
Funding: None