Rationale:
Patients with epilepsy over-utilize the emergency department (ED), leading to unnecessary ED visits and hospitalizations. As the initial stage of a quality improvement project focusing on reduction of low acuity admissions, we collected data looking at patient demographics and reasons for repeat presentation to the ED to identify key drivers influencing repeat ED visits, including the potential influence of disparities in care.
Methods:
Data collection was undertaken for all patients with an ICD-10 epilepsy or seizure diagnosis as the primary reason for an ED visit across all OhioHealth Hospitals. Inclusion criteria included 2 or more ED visits from 7/2024 through 12/2024. A manual chart review was conducted for collection of the following data points: Age, Sex, insurance type, ED visit location, home zip code, antiseizure medication (ASM) regimen, presence of a rescue therapy prescription, and reason for ED presentation.
Results:
A total of 72 unique patients utilized the ED 2 or more times during the 6-month time frame (accounting for a total of 402 visits), with 8 patients comprising 40% of these total visits. Mean patient age was 40.6 years (55% male, 45% female). Race/Ethnicity included 40 (57%) Caucasian, 22 (30%) Black, 3 (4%) Asian, and 4 (5%) Hispanic. Most patients (43, or 57%) had a version of Medicaid, while 12 (17%) had Medicare, 13 (31%) Commercial, and 3 (4%) no insurance. Medicaid patients accounted for 63% of all ED visits, Medicare 21%, and Commercial 12%.
Despite a seizure or epilepsy related ICD-10 code being used for the visit, per chart review 32% of the total encounters were for nonrelated health issues. 46% of visits were related to medication nonadherence (commercial insurance 2 visit, Medicaid 115 visits, and Medicare 44 visits; Black 92 visits, White 52 visits). Only 28 (31%) were prescribed some form of rescue therapy. 31% of patients had confirmed or suspected PNES, accounting for nearly 50% of total visits. Conclusions:
Data analysis for this QI project highlights several important trends and identifies opportunities to improve patient care related to health disparities, with Medicaid patients accounting for a majority of visits, primarily due to issues with medication adherence. Black patients were much more likely to visit the ED for nonadherence than Caucasian patients. The prevalence of confirmed or suspected PNES in this cohort reiterates the importance of early PNES identification and treatment.
The next phase of this project will aim to address the key drivers contributing to repeat ED visits leading to low acuity admissions including medication adherence, seizure action plans, prescription of rescue medications, and ensuring appropriate referral to the epilepsy clinic.
Funding: N/A