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Kregel M, Coulson S, Nabavi Nouri M, Sorzano R, Andrade A. Families' Knowledge Change in Paediatric Drug Resistant Epilepsy: A Novel Clinic Model. Seizure 2023; 108:116-126. [PMID: 37146515 DOI: 10.1016/j.seizure.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Epilepsy is a chronic condition that affects approximately 95,000 Ontarians, of whom approximately 15,000 are children under the age of 18. Drug resistant epilepsy (DRE) will affect around 30% of these children who will require more advanced care due to their medical complexities. The purpose of this study is to determine if receiving care in a paediatric Comprehensive Epilepsy Clinic (CEC) is associated with positive outcomes for children living with DRE and their families by looking at three health outcomes: 1) families' knowledge of their child's diagnosis and treatment plan, 2) navigational access to both the hospital and community epilepsy services, and 3) health behaviours. METHODS This was a prospective cohort study in which families of children diagnosed with DRE would be exposed to a CEC care model for the first time and followed for 6-months after enrollment. This was analyzed by utilizing surveys from new families at baseline and 6 months post receiving care within a CEC. RESULTS Results revealed a statistical significance in change of knowledge in families' knowing the type of epilepsy their child has and what epilepsy co-morbidities are. Families' also had a significant change in utilizing hospital epilepsy resources and knowing who to contact in the community and hospital for their epilepsy related questions. CONCLUSION A CEC model improves families' knowledge about epilepsy diagnosis and treatment plan, navigational access to both the hospital and community epilepsy services, and health behaviours.
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Affiliation(s)
- Michelle Kregel
- Children's Hospital, London Health Sciences, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada; Lawson Health Research Institute, 750 Baseline Rd E, London, Ontario N6C 2R5, Canada.
| | - Sherry Coulson
- Department of Paediatrics, Western University, 1151 Richmond St, London, Ontario N6A 5C1, Canada
| | - Maryam Nabavi Nouri
- Department of Paediatrics, Schulich School of Medicine & Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada
| | - Rochelle Sorzano
- Lawson Health Research Institute, 750 Baseline Rd E, London, Ontario N6C 2R5, Canada
| | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine & Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada
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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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3
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Kwon CS, Wong B, Agarwal P, Lin JY, Mazumdar M, Dhamoon M, Jetté N. Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population-based study. Epilepsia 2020; 61:1969-1978. [PMID: 32808690 DOI: 10.1111/epi.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identifying adverse outcomes and examining trends and causes of nonelective admissions among persons with epilepsy would be beneficial to optimize patient care and reduce health services utilization. We examined the association of epilepsy with discharge status, in-hospital mortality, length-of-stay, and charges. We also examined 10-year trends and causes of hospital admissions among those with and without epilepsy. METHODS Nonelective hospital admission in persons with epilepsy was identified in the 2005-2014 National Inpatient Sample (NIS) using a validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) case definition. The NIS is the largest US all-payer database including patient and hospital-level variables, and represents hospitalizations in the general population. Descriptive statistics on trends and causes of admissions and multivariable regression analysis summarizing the association of epilepsy with the outcomes of interest are presented. RESULTS Of 4 718 178 nonelective admissions in 2014, 3.80% (n = 179 461) were in persons with epilepsy. Admissions in persons with epilepsy increased from 14 636 to 179 461 (P < .0001) between 2005 and 2014. As compared to persons without epilepsy, hospital admissions in persons with epilepsy had higher odds of transfer to other facilities (odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.72-1.81, P < .0001), being discharged against medical advice (OR = 1.48, 95% CI: 1.38-1.59, P < .0001), and incurring 4% greater total charges (P < .0001). Epilepsy, convulsions, pneumonia, mood disorders, cerebrovascular disease, and septicemia were the top causes for admissions in those with epilepsy. SIGNIFICANCE Future research should focus on designing targeted health care interventions that decrease the number of hospital admissions, reduce health services utilization, and increase the odds of discharge home in people with epilepsy.
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Affiliation(s)
- Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bonnie Wong
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jung-Yi Lin
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Patel AD, Wood EG, Cohen DM. Reduced Emergency Department Utilization by Patients With Epilepsy Using QI Methodology. Pediatrics 2017; 139:peds.2015-2358. [PMID: 28108581 DOI: 10.1542/peds.2015-2358] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model. Our defined outcome was to decrease ED utilization for children with epilepsy. Rate of ED visits as well as unplanned hospitalizations for epilepsy patients and associated health care costs were determined. A QI team was developed for this project. Plan do study act cycles were used with adjustments made when needed. RESULTS Nineteen months after implementation of the interventions, ED visits were reduced by 28% (from 17 visits per month per 1000 patients to 12.2 per month per 1000 patients) during the past year. The average number of inpatient hospitalizations per month was reduced by 43% from 7 admissions per month per 1000 patients to 4 admissions per month per 1000 patients. For both outcome measures, a 2-sample Poisson rate exact test yielded a P value < .0001. Health care claims paid were less with $115 200 reduction for ED visits and $1 951 137 reduction for hospitalizations. CONCLUSIONS Applying QI methodology was highly effective in reducing ED utilization and unplanned hospitalizations for children with epilepsy at a free-standing children's hospital.
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Affiliation(s)
- Anup D Patel
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and .,Divisions of Neurology and
| | - Eric G Wood
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; and.,Emergency Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Kern LM, Grinspan Z, Shapiro JS, Kaushal R. Patients' Use of Multiple Hospitals in a Major US City: Implications for Population Management. Popul Health Manag 2016; 20:99-102. [PMID: 27268133 DOI: 10.1089/pop.2016.0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding how often patients seek care from multiple hospitals is important for care of individuals and populations, but it is not routinely measured because of lack of data. This study used data from a health information exchange (HIE) to measure the frequency with which patients seek care from multiple hospitals. This was a retrospective cohort study (2010-2011) of all patients who sought emergency department (ED) or inpatient care at 6 participating hospitals in Manhattan. The study found that all 6 hospitals shared patients with each of the other hospitals and that 10.0% of all ED visits and 9.1% of all admissions were for patients who had been seen in a different hospital in the past 12 months. Patients are frequently seen by multiple hospitals, which poses a challenge for clinical care and population management. By capturing which patients are seen where and when, HIEs are well suited for facilitating population management.
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Affiliation(s)
- Lisa M Kern
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York
| | - Zachary Grinspan
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York.,4 Department of Pediatrics, Weill Cornell Medicine , New York, New York.,5 New York-Presbyterian Hospital , New York, New York
| | - Jason S Shapiro
- 6 Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Rainu Kaushal
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York.,4 Department of Pediatrics, Weill Cornell Medicine , New York, New York.,5 New York-Presbyterian Hospital , New York, New York
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