Abstracts

Rationale: An estimated 50 million people worldwide have epilepsy. If properly diagnosed and treated, nearly 70% of people with epilepsy could become seizure free. Yet, despite treatment advances, there is often a 20-year delay between diagnosis and surgical management of refractory epilepsy.

The aim of this QI project was to increase the percentage of general neurology referrals to the Epilepsy Clinic and/or Epilepsy Monitoring Unit (EMU) within our health system.


Methods: We previously identified a gap in care for refractory epilepsy patients within our health system. Baseline data from 6/2018-6/2019 revealed that only 20% of refractory patients were referred to the epilepsy clinic or EMU. From 7/2019-1/2022, extensive educational efforts were undertaken for general neurology, without a significant improvement in referral rates (p=0.841, 2 sample t-test).

This QI project was conducted with Six-Sigma methodology with the aim of improving referral patterns. We developed an algorithm to identify refractory epilepsy patients, using ICD-10 epilepsy codes and anticonvulsant prescriptions. We examined the number of refractory epilepsy patients were referred to epilepsy clinic or EMU, and number of refractory (Fig.1). We examined drivers that may impact referral rates, and a process map was developed to identify failure modes and causes (Fig. 2). Two focus areas appeared to provide the largest gaps in care: patients not being identified as being refractory and ability to travel to epilepsy center.

A multi-step improvement process was developed including: presentation of, in person meetings with several general neurologists, creation of a mandatory EMR flowsheet, screening of new referrals, and development of epilepsy outreach clinic strategy.


Results: Prior to our interventions, 24 of our general neurology providers throughout Ohio collectively managed 456 refractory patients, with an average of 19 patients per provider (7/2019-1/2022). Following our interventions, these numbers decreased to 157 and 6.5, respectively (8/2022-4/2024), Fig 1. The largest number of refractory patients remaining with general neurologists live in rural areas, >1 hour from the central epilepsy center.

There was an average of 61% compliance with Flowsheet completion. We saw a 20% increase in appropriate referrals by general neurology to the EMU. Six outreach clinic sites were developed in rural and inner city areas.




Conclusions: Bridging the gap in epilepsy care requires innovative solutions. Meetings with general neurologists identified a geographic gap with many patients being unable to travel to the epilepsy center, consistent with known disparities in care. Our outreach clinics are helping to bridge this gap. Future related activities can include tracking time to surgery, cost of care due to variability in practice, and development of novel patient care models with the development of the CMS epilepsy specialty code. Overall, this was a successful QI project to help bridge the gap in epilepsy care and increase referrals from general neurology to the EMU and epilepsy clinic.

Funding: N/A