Readmission after epilepsy monitoring unit discharge in a nationally representative sample

Blank, Leah J.; Agarwal, Parul

doi:10.1016/j.eplepsyres.2021.106670

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…Similar to prior work [14], we included patients with epilepsy, defined as filling at least one antiseizure medication (ASM), plus either of the following International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) criteria for inpatient, outpatient, or emergency Evaluation and Management (E/M) or consultation codes: 1) at least one for epilepsy (345.xx), or 2) at least two for convulsions (780.3x) at least thirty days apart, in 2014. Recent work in Medicare [15] demonstrated good performance of combining ICD-9 codes plus ASM to identify patients with epilepsy (c-statistic 0.93, sensitivity 88%, and specificity 98%), and other recent investigations have used 2014 data given ICD-10 codes beginning in 2015 are less well validated [16,17]. We excluded beneficiaries without continuous enrollment in Medicare parts A and B, or with managed care plans (whose claims do not appear in Medicare carrier files) in 2012-2014 to allow a two-year lookback period (2012-2013) for baseline data.…”

Section: Patient Selectionmentioning

confidence: 99%

Polypharmacy composition and patient- and provider-related variation in patients with epilepsy

Terman

Aubert

Maust

et al. 2022

Epilepsy & Behavior

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Objective: To describe polypharmacy composition, and the degree to which patients versus providers contribute to variation in medication fills, in people with epilepsy. Methods: We performed a retrospective study of Medicare beneficiaries with epilepsy (antiseizure medication plus diagnostic codes) in 2014 (N = 78,048). We described total number of medications and prescribers, and specific medications. Multilevel models evaluated the percentage of variation in two outcomes (1. number of medications per patient-provider dyad, and 2. whether a medication was filled within thirty days of a visit) due to patient-to-patient differences versus provider-to-provider differences. Results: Patients filled a median of 12 (interquartile range [IQR] 8-17) medications, from median of 5 (IQR 3-7) prescribers. Twenty-two percent filled an opioid, and 61% filled at least three central nervous system medications. Levetiracetam was the most common medication (40%), followed by hydrocodone/ acetaminophen (27%). The strongest predictor of medications per patient was Charlson comorbidity index (7.5 [95% confidence interval (CI) 7.2-7.8] additional medications for index 8+ versus 0). Provider-to-provider variation explained 36% of variation in number of medications per patient, whereas patient-to-patient variation explained only 2% of variation. Provider-to-provider variation explained 57% of variation in whether a patient filled a medication within 30 days of a visit, whereas patient-to-patient variation explained only 30% of variation. Conclusion: Patients with epilepsy fill a large number of medications from a large number of providers, including high-risk medications. Variation in medication fills was substantially more related to provider-to-provider rather than patient-to-patient variation. The better understanding of drivers of high-prescribing practices may reduce avoidable medication-related harms.

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