Abstracts

Individuals admitted to urban hospitals with admitting diagnosis of seizure/epilepsy are more difficult to care for. Barriers to seizure control may include more severe disease, personal habits, failure to comprehend medication instructions or communicate health care needs. This can result in increased readmission rates for recurrent seizures, medication toxicity or other seizure related injury. CareScience Care Management System[trade] (CSM) software was utilized to identify 305 individuals admitted to our urban, tertiary care hospital from 7/02-6/03 with a primary diagnosis of seizures (SZ) or epilepsy (EPD). Data included morbidity, mortality, complications, length of stay (LOS), payor mix, admission source and disposition. Readmission rates within 30 days for any cause, but specifically for epilepsy related causes were compared to a group of 1159 individuals also suffering from epilepsy but admitted during same time period for conditions other than epilepsy. Readmission rate for epilepsy as primary diagnosis was 9.2%. (28 of 305). Readmission for an epilepsy related cause was 11/28 . In contrast, among individuals with epilepsy admitted to hospital for other diagnoses (Epilepsy as secondary diagnosis ESD) had a readmission rate of 21.1% with only 2% (20 of 1159) readmissions attributable to epilepsy or associated morbidity. EPD subjects had a mean age of 47.6 years and LOS 3.7 days. In contrast the ESD group had mean age of 53.8 years and LOS of 8.4 days. The ESD group was a sicker population with 3.2 fold morbidity rate and 2.4 fold complication rate compared to EPD population.
While 84% of the EPD group was admitted from the emergency ward, mean travel distance was 15.5 miles, hence this group is represents the metropolitan region. 77% of the subjects were discharged home, 7.2% left against medical advice. Mean time until the second hospitalization was 16.6 days for recurrent seizures and 15.8 days for AED toxicity. In the EPD group, co-morbid alcohol or drug abuse identified in 23% of cases and was not associated with increased risk for readmission. CSM[trade] was useful in formulation of optimum treatment protocols to improve clinical quality in epilepsy care. It identified a trend towards recurrent hospital use for individuals hospitalized for seizures. Most of the initial hospitalizations are brief, but complete control of seizures is not accomplished during that hospitalization given the rate of readmission and the incidence of AED toxicity.
Issues that are likely to contribute to readmission may be missed by this software include cost and access to medicine. Most readmissions occur 10-26 days after discharge, before subjects have outpatient follow-up. Based on this data, our institution will develop care plans that address factors leading to incomplete seizure control.