دورية أكاديمية
أعرض في EDS

Predictors of referral for long-term EEG monitoring for Medicare beneficiaries with drug-resistant epilepsy.

التفاصيل البيبلوغرافية
العنوان: Predictors of referral for long-term EEG monitoring for Medicare beneficiaries with drug-resistant epilepsy.
المؤلفون: Hill CE; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA., Lin CC; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.; Department of Neurology, The Ohio State University, Columbus, Ohio, USA., Terman SW; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA., Zahuranec D; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA., Parent JM; Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA., Skolarus LE; Department of Neurology, Northwestern University, Chicago, Illinois, USA., Burke JF; Department of Neurology, The Ohio State University, Columbus, Ohio, USA.
المصدر: Epilepsia open [Epilepsia Open] 2023 Sep; Vol. 8 (3), pp. 1096-1110. Date of Electronic Publication: 2023 Jul 22.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: John Wiley & Sons, Inc Country of Publication: United States NLM ID: 101692036 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2470-9239 (Electronic) Linking ISSN: 24709239 NLM ISO Abbreviation: Epilepsia Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Hoboken, New Jersey : John Wiley & Sons, Inc., [2016]-
مواضيع طبية MeSH: Electroencephalography*/economics , Monitoring, Physiologic*/economics , Drug Resistant Epilepsy*/diagnosis , Drug Resistant Epilepsy*/economics , Drug Resistant Epilepsy*/surgery , Insurance Benefits*, Medicare ; Long-Term Care ; Humans ; Male ; Young Adult ; Adult ; Middle Aged ; Referral and Consultation ; Female
مستخلص: Objective: For people with drug-resistant epilepsy, the use of epilepsy surgery is low despite favorable odds of seizure freedom. To better understand surgery utilization, we explored factors associated with inpatient long-term EEG monitoring (LTM), the first step of the presurgical pathway.
Methods: Using 2001-2018 Medicare files, we identified patients with incident drug-resistant epilepsy using validated criteria of ≥2 distinct antiseizure medication (ASM) prescriptions and ≥1 drug-resistant epilepsy encounter among patients with ≥2 years pre- and ≥1 year post-diagnosis Medicare enrollment. We used multilevel logistic regression to evaluate associations between LTM and patient, provider, and geographic factors. We then analyzed neurologist-diagnosed patients to further evaluate provider/environmental characteristics.
Results: Of 12 044 patients with incident drug-resistant epilepsy diagnosis identified, 2% underwent surgery. Most (68%) were diagnosed by a neurologist. In total, 19% underwent LTM near/after drug-resistant epilepsy diagnosis; another 4% only underwent LTM much prior to diagnosis. Patient factors most strongly predicting LTM were age <65 (adjusted odds ratio 1.5 [95% confidence interval 1.3-1.8]), focal epilepsy (1.6 [1.4-1.9]), psychogenic non-epileptic spells diagnosis (1.6 [1.1-2.5]) prior hospitalization (1.7, [1.5-2]), and epilepsy center proximity (1.6 [1.3-1.9]). Additional predictors included female gender, Medicare/Medicaid non-dual eligibility, certain comorbidities, physician specialties, regional neurologist density, and prior LTM. Among neurologist-diagnosed patients, neurologist <10 years from graduation, near an epilepsy center, or epilepsy-specialized increased LTM likelihood (1.5 [1.3-1.9], 2.1 [1.8-2.5], 2.6 [2.1-3.1], respectively). In this model, 37% of variation in LTM completion near/after diagnosis was explained by individual neurologist practice and/or environment rather than measurable patient factors (intraclass correlation coefficient 0.37).
Significance: A small proportion of Medicare beneficiaries with drug-resistant epilepsy completed LTM, a proxy for epilepsy surgery referral. While some patient factors and access measures predicted LTM, non-patient factors explained a sizable proportion of variance in LTM completion. To increase surgery utilization, these data suggest initiatives targeting better support of neurologist referral.
(© 2023 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)
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معلومات مُعتمدة: K23 NS126495 United States NS NINDS NIH HHS; KL2 TR002241 United States TR NCATS NIH HHS; UL1 TR002240 United States TR NCATS NIH HHS
فهرسة مساهمة: Keywords: epilepsy surgery; neurologist referral; presurgical evaluation; video EEG
تواريخ الأحداث: Date Created: 20230709 Date Completed: 20230905 Latest Revision: 20240523
رمز التحديث: 20240523
مُعرف محوري في PubMed: PMC10472378
DOI: 10.1002/epi4.12789
PMID: 37423646
قاعدة البيانات: MEDLINE
الوصف
تدمد:2470-9239
DOI:10.1002/epi4.12789