Evaluation of a Care Management Program for Pediatric Epilepsy Patients

Abstract

Objective: To evaluate the impact of a pediatric epilepsy care management intervention on emergency department visits, hospitalizations, and seizure freedom. Methods: We conducted a prospective observational study at a single academic medical center. Children with epilepsy with high risk of frequent emergency department use were enrolled in the intervention from January through May 2015, which included a baseline visit and follow-up support from a care management team. Controls selected from the same institution received standard of care. Baseline and follow-up information were collected from electronic health records and surveys (Family Impact Scale, Pediatric Epilepsy Medication Self-Management Questionnaire). Propensity score–weighted logistic regression compared emergency department visits, unplanned hospitalizations, and 3-month seizure freedom after 1 year in the intervention vs control groups. Results: A total of 56 children were enrolled in the intervention and 359 received standard of care. The intervention group was younger and had greater use of health services at baseline. When comparing the intervention to standard of care after 1 year, we found no significant difference in the risk of any emergency department visit (adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 0.6-8.5) or seizure freedom (adjusted OR 2.5, 95% CI 0.3-21.5). However, the risk of unplanned hospital admissions remained higher in the intervention group (adjusted OR 23.1, 95% CI 5.1-104). Conclusion: We did not find that children with epilepsy who received a care management intervention had less use of health services or better clinical outcomes after a year compared with controls. The study is limited by small sample size and nonrandomized study design.

Short-stay urgent hospital admissions of children with convulsions: A mixed methods exploratory study to inform out of hospital care pathways

“…However, our findings suggest there is potential for safely reducing some SSAs related to convulsions. This could be addressed by modifying existing [ 9 ] or developing new pre- and post-hospital evidence-based guidelines to manage childhood convulsions in the community and address parents’ concerns. Future research would be of merit to investigate the impact of implementation of such guidelines and interventions on SSAs for convulsions.…”

“…Assuming that the convulsions are not complex in nature, that the child has recovered completely, and that parental reassurance, education, and safety netting has been provided, hospitalisation is seldom required and any further convulsions can usually be safely managed at home or in the community [5][6][7][8]. High levels of ED attendance and SSAs could indicate poor management of the condition, challenges in accessing specialist care, or that parents feel unable to manage a convulsion at home [9][10].…”

“…The Flow of Admissions in Children and Young People (FLAMINGO) project was undertaken in response to the growing number of paediatric urgent hospital admissions in the UK [4][5][6][7][8][9][10][11], explained largely by rising SSAs [4,12]. This exploratory sequential mixed-methods study aimed to improve understanding of SSAs in Scotland through linkage of national databases to identify referral pathways and characteristics of SSAs.…”

Predicting Patient No-Shows in an Academic Pediatric Neurology Clinic

“…Ambulatory care–sensitive conditions are conditions for which appropriate outpatient care can improve patient satisfaction and decrease unplanned health care utilization. 1 During outpatient visits, interventions applied to children with epilepsy help control seizures, ensure proper rescue medication dosing, 2 improve education, 3 avoid treatment side effects, and address quality of life. 4 These interventions can enhance overall knowledge and understanding of seizures and epilepsy care.…”

“…9,10 However, personal calls by staff is labor-intensive and may require additional staffing resources. 1 Therefore, predicting patients likely to not show for an outpatient clinic appointment can maximize using limited resources and prioritize those that would benefit most from targeted interventions.…”