Hospital crossover increases utilization for people with epilepsy: A retrospective cohort study

Abstract

Objectives “Hospital crossover” occurs when people visit multiple hospitals for care, which may cause gaps in electronic health records. Although crossover is common among people with epilepsy, the effect on subsequent use of health services is unknown. Understanding this effect will help prioritize healthcare delivery innovations targeted for this population. Methods We collected de-identified information from a health information exchange network describing 7836 people with epilepsy who visited any of seven hospitals in New York, NY from 2009–2012. Data included demographics, comorbidities, and two years of visit information from ambulatory, inpatient, emergency department (ED), and radiology settings. We performed two complementary retrospective cohort analyses, in order to (1) illustrate the effect on a carefully selected subgroup, and (2) confirm the effect across the study population. First, we performed a matched cohort analysis on 410 pairs of individuals with and without hospital crossover in the baseline year. Second, we performed a propensity score odds weighted ordinal logistic regression analysis to estimate the effect across all 7836 individuals. The outcomes were the use of six health services in the follow-up year. Results In the matched pair analysis, baseline hospital crossover increased the odds of more visits in the ED (odds ratio [95%CI] 1.42 [1.05,1.95]) and radiology settings (1.7 [1.22,2.38]). The regression analysis confirmed the ED and radiology findings, and also suggested crossover lead to more inpatient admissions (1.35 [1.11,1.63]), head CTs (1.44 [1.04,2]), and brain MRIs (2.32 [1.59,3.37]). Significance Baseline hospital crossover is an independent marker for subsequent increased health service use in multiple settings among people with epilepsy. Healthcare delivery innovations targeted for people with epilepsy who engage in hospital crossover should prioritize (1) sharing radiology images and reports (to reduce unnecessary radiology use, particularly head CTs), and (2) improving coordination of care (to reduce unnecessary ED and inpatient use).

Decreasing Emergency Department Visits for Children With Epilepsy

“…1 Epilepsy or seizure care remains the most common neurologic condition that presents to an ED, with the majority of patients with an ED visit being less than 5 years of age. [2][3][4][5][6] In previous reports, seizure-related ED visits were frequently felt unnecessary by the patient, caregiver, or provider, with many of these visits being considered preventable. 1,[7][8][9] ED visits lead to a high cost to the health care system 1,6,7,[10][11][12] in claims data; however, this cost may not capture the full financial burden and social impact of ED visits for seizure care.…”

Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

“…[2][3][4] Although some studies in the United States address health services utilization and trends in hospital admissions in persons living with epilepsy, some of these studies have limitations. [3][4][5][6][7] Some used older data, 6,7 whereas other studied cohorts limited to a single payer group, 3 specific geographic region(s), 4 or age group(s). 5 Such studies are important because hospitalizations are a leading driver of healthcare costs nationally, and represent a large component of the direct costs of epilepsy.…”

“…An estimated 3.4 million people in the United States have epilepsy 1 . Epilepsy has serious health consequences and is associated with increased health services utilization and higher direct and indirect costs 2–4 . Although some studies in the United States address health services utilization and trends in hospital admissions in persons living with epilepsy, some of these studies have limitations 3–7 .…”

“…Epilepsy has serious health consequences and is associated with increased health services utilization and higher direct and indirect costs 2–4 . Although some studies in the United States address health services utilization and trends in hospital admissions in persons living with epilepsy, some of these studies have limitations 3–7 . Some used older data, 6,7 whereas other studied cohorts limited to a single payer group, 3 specific geographic region(s), 4 or age group(s) 5 …”