Hospital crossover increases utilization for people with epilepsy: a retrospective cohort study.

TitleHospital crossover increases utilization for people with epilepsy: a retrospective cohort study.
Publication TypeJournal Article
Year of Publication2015
AuthorsGrinspan ZM, Shapiro JS, Abramson EL, Jung H-Y, Kaushal R, Kern LM
Date Published2015 Jan
KeywordsAdolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Electronic Health Records, Emergency Service, Hospital, Epilepsy, Female, Health Services, Hospitalization, Hospitals, Humans, Infant, Infant, Newborn, Male, Middle Aged, Outpatient Clinics, Hospital, Radiology Department, Hospital, Retrospective Studies, Young Adult

OBJECTIVES: "Hospital crossover" occurs when people visit multiple hospitals for care, which may cause gaps in electronic health records. Although crossover is common among people with epilepsy, the effect on subsequent use of health services is unknown. Understanding this effect will help prioritize health care delivery innovations targeted for this population.

METHODS: We collected de-identified information from a health information exchange network describing 7,836 people with epilepsy who visited any of seven hospitals in New York, NY from 2009-2012. Data included demographics, comorbidities, and 2 years of visit information from ambulatory, inpatient, emergency department (ED), and radiology settings. We performed two complementary retrospective cohort analyses, in order to (1) illustrate the effect on a carefully selected subgroup, and (2) confirm the effect across the study population. First, we performed a matched cohort analysis on 410 pairs of individuals with and without hospital crossover in the baseline year. Second, we performed a propensity score odds weighted ordinal logistic regression analysis to estimate the effect across all 7,836 individuals. The outcomes were the use of six health services in the follow-up year.

RESULTS: In the matched pair analysis, baseline hospital crossover increased the odds of more visits in the ED (odds ratio 1.42, 95% confidence interval [CI] 1.05-1.95) and radiology settings (1.7, 1.22-2.38). The regression analysis confirmed the ED and radiology findings, and also suggested that crossover led to more inpatient admissions (1.35, 1.11-1.63), head CTs (1.44, 1.04-2), and brain MRIs (2.32, 1.59-3.37).

SIGNIFICANCE: Baseline hospital crossover is an independent marker for subsequent increased health service use in multiple settings among people with epilepsy. Health care delivery innovations targeted for people with epilepsy who engage in hospital crossover should prioritize (1) sharing radiology images and reports (to reduce unnecessary radiology use, particularly head CTs), and (2) improving coordination of care (to reduce unnecessary ED and inpatient use).

Alternate JournalEpilepsia
PubMed ID25571986
PubMed Central IDPMC4610742
Grant ListL40 NS080273 / NS / NINDS NIH HHS / United States
K12-HL109005 / HL / NHLBI NIH HHS / United States
K12 NS066274 / NS / NINDS NIH HHS / United States
K12 HL109005 / HL / NHLBI NIH HHS / United States
R01 HS021261 / HS / AHRQ HHS / United States
K12-NS0662 / NS / NINDS NIH HHS / United States
R01-HS021261 / HS / AHRQ HHS / United States
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