Abstracts

Rationale: The annual cost of pediatric epilepsy in the US is about $9.6 billion. Emergency room (ER) visits and hospital admissions account for 45 to 67 percent of the total direct health related cost of epilepsy. A coordinated care approach has successfully decreased ER visits in many other chronic illnesses. Published reports from single centers suggest care coordination can reduce ER visits in selected groups of children with refractory epilepsy, but the generalizability of such findings is unknown.Methods: We identified a sample of patients with refractory epilepsy (more than two antiepileptic medications) with frequent ER visits and/or hospital admissions. Following a clinic visit with a child neurology provider, we used a checklist (adapted from Patel 2014) to review medications, customize an emergency seizure action plan, and administer a quality of life survey. A social work intern completed monthly phone calls for the first three months, where she addressed seizure frequency, semiology, medication side effects, emergency preparedness, and general health concerns. We tallied interventions that resulted from each call. At six months we re-administered the quality of life assessment. We reviewed several measures in the six months prior and six months during the intervention, including hospital admissions, ER and outpatient visits, seizure frequency, and quality of life. We estimated health related costs in the six months prior and during the intervention, based on published values for pediatric epilepsy inpatient admissions and ER visits. We interviewed the social work intern (NZ) to identify challenges and successes of the intervention.Results: We enrolled five subjects. Out of the ninteen total calls (thus far), 42% resulted in urgent medication refills, 32% resulted in scheduling a follow-up appointment, 26% required a social work intervention, and 16% resulted in troubleshooting medication adminsitration. During the study period, subjects had fewer seizures, fewer hospital admissions (6 down to 4), and fewer ER visits (7 down to 1). The number of outpatient visits decreased for two of four patients. The estimated cost of ER visits and hospital admissions was $71,500 in the six months prior to the study, compared to $38,500 during. The social worker described the value of combining in-person and phone contact, completing social work interventions, finding solutions to cultural barriers, coordinating subspecialty services, and educating patients on rescue medication. Improving communication between pharmacy and insurance companies and reaching some families over the phone were significant challenges.Conclusions: We confirm that a care coordinated approach to refractory pediatric epilepsy can successfully decrease ER visits and hospital admissions. Care management tasks should include improving coordination between services, scheduling appointments, medication tasks (refills and education), and social work interventions. Further work is indicated to understand the potential cost savings of a care-management intervention.