Increasing Equitable Access to Standardized Epilepsy Self-management: Engaging Primary Care Clinics in Northern New England
Abstract number :
3.155
Submission category :
17. Public Health
Year :
2024
Submission ID :
549
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Trina Dawson, BA, CHW – Dartmouth-Hitchcock Medical Center
Tim Burdick, MD, MSc – Dartmouth Hitchcock Medical Center
Barbara Jobst, MD, PhD – Dartmouth-Hitchcock Medical Center
Meagan Stabler, PhD – Dartmouth Hitchcock Medical Center
Carla Tarzia, RN – Dartmouth Hitchcock Medical Center
Laura De Muro, MS, CHW – Dartmouth-Hitchcock Medical Center
Sarah Kaden, BA – Dartmouth-Hitchcock Medical Center
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth-Hitchcock Medical Center
Rationale: Barriers to optimal epilepsy management are complex and involve individual, community and health system factors. Mobilizing primary care clinicians, who often are the sole providers of epilepsy care, to champion standardized epilepsy self-management (ESM) in their clinical practice is key to bringing coordinated change to current systems of care and improving support for people with epilepsy (PWE). This implementation project pilots a quality improvement (QI) health systems approach that incorporates provider education and clinical decision support via the EHR to coordinate access for PWE who may benefit from participation in the telehealth deliverable HOBSCOTCH (HOme Based Self-Management and COnitive Training CHanges Lives) program.
Methods: The HOBSCOTCH Institute (HI) engaged Dartmouth Health Informatics and the Northern New England (NNE) CO-OP Primary and Community Practice Based Research Network (Figure 1), a network of primary care clinicians and health professionals across NH, VT and ME, to propel an effort that would increase provider and patient access to the HOBSCOTCH intervention. An embedded EHR best practice alert (BPA) was developed and tested to provide decision support for clinicians. Six primary care practices were systematically onboarded from January to May, 2024. Onboarding included tailored education sessions for practice teams highlighting the management needs of PWE, the frequent comorbidity of cognitive dysfunction and an introduction to evidence based telehealth deliverable HOBSCOTCH. Following education sessions the EHR BPA was activated and referral of patients to the HI was possible with "one-click". Referrals are managed by HI coordinators.
Results: Provider engagement was high. A total of 121 primary care patients referrals (Male 65; Female 49; other 1; 96.5% white and 99% not Hispanic or Latino) across a spectrum of ages (years of age: 18-24 = 8; 25-34 =13; 35-44=23; 45-54 =16; 55+ = 55) were received by the HOBSCOTCH Institute team via the EHR embedded BPA from January 18, 2024 to May 31, 2024. (Figure 2) A steady increase in the number of referrals was seen with the onboarding of clinics, beginning with one pilot clinic site in January, and increasing to a total of 6 clinic sites by May. In total 36 unique multidisciplinary providers (physicians = 22; APPs = 12) contributed to referrals to the HOBSCOTCH program.
Conclusions: We share the first ESM implementation model that engages a network of primary care providers in the referral of patients to a targeted ESM program for PWE and cognitive challenges, HOBSCOTCH. As evidenced by the high rate of referrals, providers at partnering sites are committed to sharing this evidence based resource with their patients who have epilepsy. Our model is scalable and will allow for penetration of safety net clinics (FQHCs, community center clinics) in rural and underserved areas to facilitate increasing equitable access to higher quality epilepsy care inclusive of the evidence-based self-management intervention HOBSCOTCH.
Funding: Centers for Disease Control and Prevention 1NU58DP007541-01-00
Public Health