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Patel AD, Debs A, Terry D, Parker W, Burch M, Luciano D, Patton L, Brubaker J, Chrisman J, Moellman K, Herbst J, Cohen DM. Decreasing Emergency Department Visits for Children With Epilepsy. Neurol Clin Pract 2021; 11:413-419. [PMID: 34840868 DOI: 10.1212/cpj.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives Epilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy. Methods In 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible. Our aim statement was to decrease the number of ED visits, per 1000 established patients with epilepsy, from 13.03 to 11.6, by December 2019 and sustain for 1 year. Results We successfully decreased ED visits for seizure-related care in patients with epilepsy from 13.03% to 10.2% per 1,000 patients, which resulted in a centerline shift. Discussion Using QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.
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Affiliation(s)
- Anup D Patel
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Andrea Debs
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debbie Terry
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - William Parker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Mary Burch
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debra Luciano
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Lauren Patton
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Jena Brubaker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Julie Chrisman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Kathy Moellman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - James Herbst
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Daniel M Cohen
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
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Davis BH, Williams K, Absher D, Korf B, Limdi NA. Evaluation of population-level pharmacogenetic actionability in Alabama. Clin Transl Sci 2021; 14:2327-2338. [PMID: 34121327 PMCID: PMC8604228 DOI: 10.1111/cts.13097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022] Open
Abstract
The evolution of evidence and availability of Clinical Pharmacogenetic Implementation Consortium (CPIC) guidelines have enabled assessment of pharmacogenetic (PGx) actionability and clinical implementation. However, population‐level actionability is not well‐characterized. We leveraged the Alabama Genomic Health Initiative (AGHI) to evaluate population‐level PGx actionability. Participants (>18 years), representing all 67 Alabama counties, were genotyped using the Illumina Global Screening array. Using CPIC guidelines, actionability was evaluated using (1) genotype data and genetic ancestry, (2) prescribing data, and (3) combined genotype and medication data. Of 6,331 participants, 4230 had genotype data and 3386 had genotype and prescription data (76% women; 76% White/18% Black [self‐reported]). Genetic ancestry was concordant with self‐reported race. For CPIC level A genes, 98.6% had an actionable genotype (99.4% Blacks/African; 98.5% White/European). With the exception of DPYD and CYP2C19, the prevalence of actionable genotypes by gene differed significantly by race. Based on prescribing, actionability was highest for CYP2D6 (70.9%), G6PD (54.1%), CYP2C19 (53.5%), and CYP2C9 (47.5%). Among participants prescribed atenolol, carvedilol, or metoprolol, ~ 50% had an actionable ADRB1 genotype, associated with decreased therapeutic response, with higher actionability among Blacks compared to Whites (62.5% vs. 47.4%; p < 0.0001). Based on both genotype and prescribing frequencies, no significant differences in actionability were observed between men and women. This statewide effort highlights PGx population‐level impact to help optimize pharmacotherapy. Almost all Alabamians harbor an actionable genotype, and a significant proportion are prescribed affected medications. Statewide efforts, such as AGHI, lay the foundation for translational research and evaluate “real‐world” outcomes of PGx.
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Affiliation(s)
- Brittney H Davis
- Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Williams
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Devin Absher
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bruce Korf
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Nita A Limdi
- Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lamsam L, Bhambhvani HP, Ratliff JK, Kvam KA. Emergent neuroimaging for seizures in epilepsy: A population study. Epilepsy Behav 2020; 112:107339. [PMID: 32911297 DOI: 10.1016/j.yebeh.2020.107339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022]
Abstract
We determined how often patients with epilepsy presented to the emergency department (ED) for seizure and the frequency and predictors for undergoing emergent neuroimaging during those visits. We conducted a retrospective population-based cohort study using administrative claims' data from 2007 to 2015. Adults with epilepsy were identified based on a diagnosis of epilepsy and an outpatient prescription for an antiepileptic medication. The Bonferroni corrected significance level was 0.0018. We identified 381,362 patients with a mean follow-up period of 1.99 years, of whom 35,015 (9.2%) patients presented to the ED for seizure at least once. Patients with at least one ED visit were younger, more likely to be male, had fewer comorbidities, and had longer follow-up as compared with those with no ED visit (all p < 0.001). Among the 35,015 patients presenting to the ED, 13.6% had neuroimaging, mostly commonly head computed tomography (CT; 95.5%). Patients undergoing neuroimaging were younger (46 versus 48 years) and with higher rates of psychosis (17.4% versus 13.8%) and depression (16.1% versus 12.2%; p < 0.001). This helps to quantify the burden of ED and emergent neuroimaging utilization for patients with epilepsy and can help inform efforts to curtail unnecessary neuroimaging.
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Affiliation(s)
- Layton Lamsam
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Hriday P Bhambhvani
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathryn A Kvam
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Carrizosa-Moog J, Isaza-Jaramillo S. Perceptions of adult and child neurologists of transition programs in epilepsy in Latin America: A cross-sectional study. Epilepsy Behav 2020; 110:107159. [PMID: 32516745 DOI: 10.1016/j.yebeh.2020.107159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to review the existence and opinion Latin American adult and child neurologists have about the development and function of transition programs in epilepsy. METHODS This was a cross-sectional study. A questionnaire was constructed with sociodemographic variables, knowledge about transition programs, barriers for building up transition programs, and 21 topics regarding the degree of involvement of healthcare providers and carers should have during the transition process. The online questionnaire was sent to 136 Latin American chapter officers registered in the International League Against Epilepsy (ILAE) webpage and to 36 clinicians assisting to the 13th Latin American Summer School on Epilepsy. RESULTS The answer rate was 68% (117/172), and all 19 Latin American countries were represented. Adult neurologists represented 60.7%. Only 16.2% knew of transition programs in epilepsy. The main limitations for transition programs were poor education about transition (76.9%), inflexible healthcare systems (75.2%), absence of financial support (61.5%), need of multidisciplinary teams (59%), and scarce communication between child and adult neurologists (53%). Providers and carers are expected to get involved at a high degree in all 21 presented topics for a transition process. The topics with highest percentage of commitment were violence and carrying weapons (93.2%), mental health (92.3%), alcohol and drugs (91.4%), suicide (90.6%), care of own's disease (90.5%), mortality risk (89.7%), and integral healthcare (92.2%). CONCLUSION Only a few transition programs exist in Latin America. Knowing the benefits of and barriers for transition programs opens the opportunity to move further this strategy in the region considering local specificities. Education, communication skills, team working, and advocacy for adolescents with epilepsy could be initial starting points.
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Affiliation(s)
- Jaime Carrizosa-Moog
- Child and Adolescent Neurology Service, Department of Pediatrics, Faculty of Medicine, University of Antioquia, Calle 18 B Sur No. 38 - 51, Medellín, Colombia.
| | - Sandra Isaza-Jaramillo
- Adult Neurology Service, Department of Internal Medicine, Faculty of Medicine, University of Antioquia, Cra. 51d # 62-29, Medellín, Colombia.
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