Abstracts

Case management (CM) coordinates patient care services in a cost-effective fashion in an effort to improve the quality of the services rendered. The objective of this pilot study was to address the initial impact of an epilepsy case management program A total of 737 patients entered a dedicated case-management program provided by a single not-for-profit, state-supported epilepsy service provider for a 4-county area in west central Florida. Initial and follow-up survey forms from 171 new consecutive patients were compared after 1 year of CM. Standardized forms supplied by the Florida Department of Health were administered in self-reported survey format upon admission. Prospective follow-up survey information was obtained and corroborated with medical record review. Changes in demographics, epilepsy measures, and QoL were assessed. All patients were managed by case managers that had obtained at least a college level education. The initial analysis of the first 30/171 patients was performed between 2002-2003. Ongoing analysis is in progress and will updated from this preliminary report. Twenty-one males and 9 females were evaluated for outcome measures after the initial year of case management. Twenty-seven completed the survey independently and three required assistance. Twenty-one of 30 (70.0%) reported ED visitation (total visits=50) the year prior to intake, while only 2/30 (6.7%) had a total of 2 visits after CM. Both the number of patients on [ldquo]new[rdquo] AEDs developed after 1993 (13/30 vs 6/30), and those reporting seizure control (26/30 vs 12/30) more than doubled. During this time available income rose in 11/30 (36.7%) with 5/30 (16.7%) newly employed. The number without depression did not change, and only 10-20% reported improvement in their energy level or being angry. However, more than 80% reported some improvement in their relationships (26/30), independence (27/30), self-appreciation (25/30) and improved QoL (27/30). Case management appears to be an effective paradigm for outpatient epilepsy patients with improved health care over several self-reported measures of income status, seizure control, and QoL. The significant reduction of ED visits before and after CM represents a potential cost savings.