Abstracts

Rationale: Background: The relationship of rising health care costs and trends in length of stay, in-hospital mortality and discharge disposition in patients admitted with epilepsy and convulsions is unknown.Our objective was to study sequential trends of health care costs, length of stay, mortality and discharge disposition of patients with epilepsy or convulsions. To determine if there is an association of health care costs trends and trends in length of stay, mortality and discharge disposition of patients with epilepsy or convulsions. Methods: Using the National Inpatient Sample (NIS) health care utilization data from the Agency of Healthcare Research and Quality, we measured the sequential trends in health care cost, length of stay, inhospital mortality and disposition for all patients admitted between 1993 and 2008. Statistical analysis were done using (95% CI, p<.05). Z test was used to see difference in mean proportions and t test was used to see difference in means. The trends were tested using Pearson`s correlation coefficient. Results: Between 1993 and 2008, the number of discharges for the diagnosis of epilepsy and/or convulsions increased from 230245 to 277395 respectively. There was a 29 percent reduction in the mean duration of hospital stay from 4.9 days ( 0.1) days in 1993 to 3.5 ( 0.1) days in 2008 ( 95% CI, p<0.001). There was 58% reduction in in-hospital mortality between 1993 and 2008, a reduction from 1.48% ( 0.07) in 1993 to 0.63% ( 0.04) in 2008 (95% CI, p<0.001). Routine discharges to home decreased from 78.6%( 0.6) to 75.5% ( 0.8) (95% CI, p<0.01) and discharges to a nursing home or rehabilitation hospital increased from 2.89% ( 0.15) to 12.84%( 0.48)(95% CI, p<0.001. Patients requiring home healthcare increased from 4.5% ( 0.23) in 1993 to 6.5%( .025) in 2008(95% CI, p<0.01. The cost-charge ratio decreased by 59% from 0.75 in 2002 to 0.31 in 2008 (95% CI, p<0.001). The hospital charges per admission billed by hospitals tripled from $7,707 to $21,571 from 1993 to 2008. The trend of increase in hospital charges inversely correlated with inpatient mortality (p<.03) and length of stay (p<.02). Conclusions: For patients admitted with epilepsy and convulsions, during the past 17 years, there seem to be statistically significant reductions in length of stay and in-hospital mortality. However proportion of patients requiring long term care increased. These changes have been accompanied by increases in health care utilization costs.