Access to Inpatient Video-EEG Monitoring for Patients with Frequent Seizure-Related Emergency Visits
Casey Kozak1, Khushi Patel1, Nikita Jadav1, Aarushi Parikh1, Kylie Getz2, Brad Kamitaki1
1Rutgers-Robert Wood Johnson Medical School, 2Rutgers School of Public Health
Objective:
The objective is to characterize barriers and facilitators to receiving video-EEG monitoring (VEEG) among patients with frequent seizure-related emergency department (ED) visits.
Background:
Seizure characterization with VEEG is a critical service for people with drug-resistant epilepsy that guides management decisions. However, racial/ethnic and socioeconomic disparities continue to prevent equitable access to epilepsy care in the US. We hypothesized that minoritized race/ethnicity, insurance barriers, and low socioeconomic status were associated with decreased access to VEEG among patients with frequent seizure-related ED visits.
Design/Methods:
This was a retrospective cohort study of patients with frequent ED visits (>2) for seizure/epilepsy in four US states (Florida, Maryland, New York, and Wisconsin) between 12/1/2016 and 12/31/2018. We identified patients who underwent inpatient VEEG during the study period. We performed a multivariable logistic regression analysis evaluating receipt of VEEG with race/ethnicity, insurance payer, and median income by zip code.
Results:
Of the 28,598 frequent ED visit cohort, 1131 (3.95%) received VEEG. No significant association was seen with any racial/ethnic group compared with White patients. Men were less likely to undergo VEEG than women (adjusted odds ratio [aOR] 0.78, 95% confidence interval[CI]: 0.69-0.88). Patients with Medicare (aOR 0.86, 95%CI: 0.71-1.05), Medicaid (aOR 0.64, 95%CI: 0.54-0.76), and no insurance (aOR 0.38, CI: 0.27-0.52) were less likely to receive VEEG compared to those with private insurance. Those living in the lowest income quartile by zip code were also less likely to undergo VEEG (aOR 0.71, 95%CI: 0.57-0.87, versus the top quartile). Living in a county with an accredited epilepsy center increased the likelihood of VEEG (aOR 1.55, 95%CI: 1.21-2.00).
Conclusions:
While we did not identify any racial/ethnic disparities in this cohort, insurance and socioeconomic factors represent significant barriers in accessing VEEG. Future efforts should focus on referring patients to the level of neurological care they need, rather than what they can afford.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.