Rationale:
Amongst all patients with epilepsy, 25% will not be seizure free with medications alone and may require invasive treatments
including epilepsy surgery to control their seizures1. The American Academy of Neurology (AAN) guidelines recommend that any patient with epilepsy not controlled with two or more medications be referred to an epilepsy surgery center for further evaluation2. Despite these recommendations, the average national time for referral to an epilepsy surgery center from time of diagnosis is 15 to 17 years3. To our knowledge, no published research studies have evaluated the time from diagnosis of seizures to referral to a surgical epilepsy center within an integrated health care delivery system such as Kaiser Permanente. We hypothesize that systematic referral barriers such as poor access to epilepsy surgery centers are less prevalent in Kaiser Permanente’s integrated health care delivery system, resulting in reduced epilepsy surgical center referral time compared to nationally reported averages. Furthermore, we hope to characterize potential ongoing systemic referral barriers within this system.
References:
1. Sander, J. W. A. S. Some Aspects of Prognosis in the Epilepsies: A Review. Epilepsia 34, 1007–1016 (1993).
2. Engel, J. et al. Practice Parameter: Temporal Lobe and Localized Neocortical Resections for Epilepsy. Epilepsia 44, 741–751 (2003).
3. Trevathan, E. & Gilliam, F. Lost years. Neurology 61, 432–433 (2003).
Methods:
An algorithm querying the Kaiser Permanente Northern California (KPNC) electronic medical record (EMR) was designed to identify the population of interest – namely, those individuals over the age of 18 who were diagnosed with epilepsy in the KPNC system and subsequently referred to the regional epilepsy centers. Notable exclusions included those with fewer than two visits with an epileptologist and who were seen prior to 2008 (before the EMR was established widely within the KPNC system). (Figure 1 details the selection process for this target population.)Results:
A total of 748 patients were identified by the EMR algorithm developed for this study. This population will be used to study the primary outcome of time to referral to a KPNC epilepsy surgery center from date of epilepsy diagnosis, and secondary outcomes of date of first prescription of an anti-seizure medication (ASM) and date of first appointment with a general neurologist. These outcomes were selected to understand the epilepsy care timeline for these patients from time of initial diagnosis. Based on these data, patients will then be grouped into those with late and early referrals to the epilepsy centers with comparison of covariates.Conclusions:
The current study designed a database query identifying patients appropriate for referral to an Epilepsy Surgery Center within an integrated health care delivery system. Time measurements to different milestones in epilepsy care for this population are forthcoming, with the goal of identifying key covariates associated with patients with early and late referrals to epilepsy centers in this system.
Funding: Kaiser Permanente Northern California, Division of Research, Rapid Analytics Unit (RAU)