Disparities in access to specialized epilepsy care

Nicholas K Schiltz, Siran M Koroukian, Mendel E Singer, Thomas E Love, Kitti Kaiboriboon, Nicholas K Schiltz, Siran M Koroukian, Mendel E Singer, Thomas E Love, Kitti Kaiboriboon

Abstract

Objective: To examine the impact of individual and community characteristics on access to specialized epilepsy care.

Methods: This retrospective cross-sectional study analyzed data from the California State Inpatient Sample, the State Ambulatory Surgery Database, and the State Emergency Department Database, that were linked with the 2009 Area Resource File and the location of the National Association of Epilepsy Center's epilepsy centers. The receipt of video-EEG monitoring was measured and used to indicate access to specialized epilepsy care in subjects with persistent seizures, identified as those who had frequent seizure-related hospital admissions and/or ER visits. A hierarchical logistic regression model was employed to assess barriers to high quality care at both individual and contextual levels.

Results: Among 115,632 persons with persistent seizures, individuals who routinely received care in an area where epilepsy centers were located were more likely to have access to specialized epilepsy care (OR: 1.81, 95% CI: 1.20, 2.72). Interestingly, the availability of epilepsy centers did not influence access to specialized epilepsy care in people who had private insurance. In contrast, uninsured individuals and those with public insurance programs including Medicaid and Medicare had significant gaps in access to specialized epilepsy care. Other individual characteristics such as age, race/ethnicity, and the presence of comorbid conditions were also associated with disparities in access to specialized care in PWE.

Conclusion: Both individual and community characteristics play substantial roles in access to high quality epilepsy care. Policy interventions that incorporate strategies to address disparities at both levels are necessary to improve access to specialized care for PWE.

Keywords: Epilepsy; Healthcare access; Healthcare disparities.

Copyright © 2013 Elsevier B.V. All rights reserved.

Figures

Figure 1
Figure 1
Location of Level 3 and Level 4 epilepsy centers in the State of California and classification of the availability of epilepsy centers by counties.

References

    1. Agency for Healthcare Research and Quality HCUP Supplemental Variables for Revisit Analyses. 2013 Retrieved July 4, 2013, from .
    1. Agency for Healthcare Research and Quality HCUP Supplemental Files for Revisit Analyses. 2012 Retrieved July 4, 2013, from .
    1. Agency for Healthcare Research and Quality HCUP Databases. 2011 Retrieved July 4, 2013, from .
    1. Andersen RM. National health surveys and the behavioral model of health services use. Med Care. 2008;46:647–653.
    1. Baca CB, Vickrey BG, Vassar S, Hauptman JS, Dadour A, Oh T, Salamon N, Vinters HV, Sankar R, Mathern GW. Time to pediatric epilepsy surgery is related to disease severity and nonclinical factors. Neurology. 2013;80:1231–1239.
    1. Baicker K, Taubman SL, Allen HL, Bernstein M, Gruber JH, Newhouse JP, Schneider EC, Wright BJ, Zaslavsky AM, Finkelstein AN, Carlson M, Edlund T, Gallia C, Smith J. The Oregon experiment--effects of Medicaid on clinical outcomes. N Engl J Med. 2013;368:1713–1722.
    1. Barcikowski RS. Statistical power with group mean as the unit of analysis. Journal of Educational and Behavioral Statistics. 1981;6:267–285.
    1. Begley CE, Basu R, Reynolds T, Lairson DR, Dubinsky S, Newmark M, Barnwell F, Hauser A, Hesdorffer D, Hernandez N, Karceski SC, Shih T. Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study. Epilepsia. 2009;50:1040–1050.
    1. Berman S, Dolins J, Tang SF, Yudkowsky B. Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics. 2002;110:239–248.
    1. Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med. 2011;364:2324–2333.
    1. Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med. 2008;358:1064–1071.
    1. Burneo JG, Jette N, Theodore W, Begley C, Parko K, Thurman DJ, Wiebe S. Disparities in epilepsy: report of a systematic review by the North American Commission of the International League Against Epilepsy. Epilepsia. 2009;50:2285–2295.
    1. Cascino GD. Clinical indications and diagnostic yield of video-electroencephalographic monitoring in patients with seizures and spells. Mayo Clin Proc. 2002;77:1111–1120.
    1. Cunningham PJ, Nichols LM. The effects of medicaid reimbursement on the access to care of medicaid enrollees: a community perspective. Med Care Res Rev. 2005;62:676–696.
    1. Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345:99–106.
    1. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.
    1. Faught E, Richman J, Martin R, Funkhouser E, Foushee R, Kratt P, Kim Y, Clements K, Cohen N, Adoboe D, Knowlton R, Pisu M. Incidence and prevalence of epilepsy among older US Medicare beneficiaries. Neurology. 2012;78:448–453.
    1. Fronstin P. California’s uninsured: treading water. 2012 Retrieved July 12, 2013, from .
    1. Gold M, Kuo S, Taylor EF. Translating research to action: improving physician access in public insurance. J Ambul Care Manage. 2006;29:36–50.
    1. Gresenz CR, Stockdale SE, Wells KB. Community effects on access to behavioral health care. Health Serv Res. 2000;35:293–306.
    1. Griggs JJ, Engel JJ. Epilepsy surgery and the racial divide. Neurology. 2005;64:8–9.
    1. Halpern MT, Renaud JM, Vickrey BG. Impact of insurance status on access to care and out-of-pocket costs for U.S. individuals with epilepsy. Epilepsy Behav. 2011;22:483–489.
    1. Hauptman JS, Dadour A, Oh T, Baca CB, Vickrey BG, Vassar SD, Sankar R, Salamon N, Vinters HV, Mathern GW. Sociodemographic changes over 25 years of pediatric epilepsy surgery at UCLA. J Neurosurg Pediatr. 2013;11:250–255.
    1. Institute of Medicine (IOM) Epilepsy across the spectrum: promoting health and understanding. The National Academic Press; Washington, DC: 2012a.
    1. Institute of Medicine (IOM) Health care: quality, access, and value. In: England MJ, Liverman CT, Schultz AM, Strawbridge LM, editors. Epilepsy across the spectrum: Promoting health and understanding. The National Academy Press; Washington DC: 2012b. pp. 113–161.
    1. Jacobson G, Neuman T, Damico A. Medicare’s role for dual eligible beneficiaries. 2012 Retrieved July 4, 2013, from .
    1. Jette N, Reid AY, Quan H, Hill MD, Wiebe S. How accurate is ICD coding for epilepsy? Epilepsia. 2010;51:62–69.
    1. Kee VR, Gilchrist B, Granner MA, Sarrazin NR, Carnahan RM. A systematic review of validated methods for identifying seizures, convulsions, or epilepsy using administrative and claims data. Pharmacoepidemiol Drug Saf. 2012;21(Suppl 1):183–193.
    1. Kelvin EA, Hesdorffer DC, Bagiella E, Andrews H, Pedley TA, Shih TT, Leary L, Thurman DJ, Hauser WA. Prevalence of self-reported epilepsy in a multiracial and multiethnic community in New York City. Epilepsy Res. 2007;77:141–150.
    1. Landon BE, Schneider EC, Normand SL, Scholle SH, Pawlson LG, Epstein AM. Quality of care in Medicaid managed care and commercial health plans. JAMA. 2007;298:1674–1681.
    1. LaPar DJ, Stukenborg GJ, Guyer RA, Stone ML, Bhamidipati CM, Lau CL, Kron IL, Ailawadi G. Primary payer status is associated with mortality and resource utilization for coronary artery bypass grafting. Circulation. 2012;126:S132–9.
    1. Litaker D, Koroukian SM, Love TE. Context and healthcare access: looking beyond the individual. Med Care. 2005;43:531–540.
    1. Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, Ko CY. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296:1973–1980.
    1. Margolis PA, Cook RL, Earp JA, Lannon CM, Keyes LL, Klein JD. Factors associated with pediatricians’ participation in Medicaid in North Carolina. JAMA. 1992;267:1942–1946.
    1. McClelland S, Curran CC, Davey CS, Okuyemi KS. Intractable pediatric temporal lobe epilepsy in the United States: examination of race, age, sex, and insurance status as factors predicting receipt of resective treatment. J Neurosurg. 2007;107:469–473.
    1. McClelland S, Guo H, Okuyemi KS. Racial disparities in the surgical management of intractable temporal lobe epilepsy in the United States: a population-based analysis. Arch Neurol. 2010;67:577–583.
    1. Mukherjee D, Zaidi HA, Kosztowski T, Chaichana KL, Brem H, Chang DC, Quinones-Hinojosa A. Disparities in access to neuro-oncologic care in the United States. Arch Surg. 2010;145:247–253.
    1. Navaneethan SD, Nigwekar S, Sengodan M, Anand E, Kadam S, Jeevanantham V, Grieff M, Choudhry W. Referral to nephrologists for chronic kidney disease care: is non-diabetic kidney disease ignored? Nephron Clin Pract. 2007;106:c113–8.
    1. Raudenbush SW, Bryk AS. Hierarchical linear models: Applications and data analysis methods. Sage Publications, Inc; 2002.
    1. Reid AY, St Germaine-Smith C, Liu M, Sadiq S, Quan H, Wiebe S, Faris P, Dean S, Jette N. Development and validation of a case definition for epilepsy for use with administrative health data. Epilepsy Res. 2012;102(3):173–179.
    1. Rosenbaum S, Sommers BD. Using medicaid to buy private health insurance - the great new experiment? N Engl J Med. 2013;369:7–9.
    1. Schiltz NK, Koroukian SM, Lhatoo SD, Kaiboriboon K. Temporal trends in pre-surgical evaluations and epilepsy surgery in the U.S. from 1998 to 2009. Epilepsy Res. 2013;103:270–278.
    1. Schneider A, Elias R. The Medicaid resource book. Kaiser Commission on Medicaid and the Uninsured; 2002.
    1. Schneider A, Strohmeyer V, Ellberger R. Medicaids eligibility for individuals with disabilities. 2000 Retrieved July 4, 2013, from .
    1. Subramanian S, Chen A. Treatment patterns and survival among low-income medicaid patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2013;139:489–495.
    1. The Henry J. Kaiser Family Foundation Medicare: a primer. 2010 Retrieved July 4, 2013, from .
    1. US Department of Health and Human Services Area Resource File (ARF) 2011 Retrieved July 4, 2013, from .
    1. Zuvekas SH, Taliaferro GS. Pathways to access: health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999. Health Aff (Millwood) 2003;22:139–153.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다