Do Centers of Excellence excel in patient outcomes?: Evidence from U.S. Veterans Health Administration Centers for Epilepsy

Kelly, Pat; Chinta, Ravi

doi:10.17722/ijme.v4i3.191

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…For instance, the Veterans Affairs health care system is a large provider within the United States, yet performed 5 resections for epilepsy in 2019 and implanted 4 neurostimulators. 32 Therefore, our analysis likely reflects accurate data regarding major trends and the current state in epilepsy care in the United States.…”

Section: Discussionmentioning

confidence: 98%

United States Epilepsy Center Characteristics

et al. 2022

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Background and Objectives:Patients with drug resistant epilepsy (DRE) may benefit from specialized testing and treatments to better control seizures and improve quality of life. Most evaluations and procedures for DRE in the United States are performed at epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). On an annual basis, the NAEC collects data from accredited epilepsy centers on hospital-based epilepsy monitoring unit (EMU) size and admissions, diagnostic testing, surgeries, and other services. This article highlights trends in epilepsy center services from 2012 through 2019.Methods:We analyzed data reported in 2012, 2016, and 2019 from all level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level and center population category. EMU beds, EMU admissions, epileptologists, and aggregate procedure volumes were also described using rates per population per year.Results:During the period studied, the number of NAEC accredited centers increased from 161 to 256, with the largest increases in adult- and pediatric-only centers. Growth in EMU admissions (41%), EMU beds (26%), and epileptologists (109%) per population occurred. Access to specialized testing and services broadly expanded. The largest growth in procedure volumes occurred in laser interstitial thermal therapy (LiTT) (61%), responsive neurostimulation (RNS) implantations (114%) and intracranial monitoring without resection (152%) over the study period. Corpus callosotomies and vagus nerve stimulator (VNS) implantations decreased (-12.8% and -2.4% respectively), while growth in temporal lobectomies (5.9%), extratemporal resections (11.9%), and hemispherectomies/otomies (13.1%) lagged center growth (59%), leading to a decrease in median volumes of these procedures per center.Discussion:During the study period, the availability of specialty epilepsy care in the U.S. improved as the NAEC implemented its accreditation program. Surgical case complexity increased while aggregate surgical volume remained stable or declined across most procedure types, with a corresponding decline in cases per center. This article describes recent data trends and current state of resources and practice across NAEC member centers and identifies several future directions for driving systematic improvements in epilepsy care.

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Section: Discussionmentioning

confidence: 98%

United States Epilepsy Center Characteristics

et al. 2022

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“…For example, the VA health care system is a large health care provider within the United States, yet performed 4 resections for epilepsy in 2020 and implanted VNS in 8 patients. 26 Therefore, our analysis likely reflects accurate data regarding the state of inpatient epilepsy care in the United States in 2020.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States

et al. 2022

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Objective:Persons with epilepsy, especially those with drug resistant epilepsy (DRE), may benefit from inpatient services such as admission to the epilepsy monitoring unit (EMU) and epilepsy surgery. The COVID-19 pandemic caused reductions in these services within the U.S. during 2020. This article highlights changes in resources, admissions and procedures among epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC).Methods:We compared data reported in 2019, prior to the COVID-19 pandemic and 2020 from all 260 level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level, center population category and geographical location. Qualitative responses from center directors to questions regarding the impact from COVID-19 were summarized utilizing thematic analysis. Responses from the NAEC center annual reports as well as a supplemental COVID-19 survey were included.Results:EMU admissions declined 23% (-21,515) in 2020, with largest median reductions in level 3 centers [-55 admissions (-44%)] and adult centers [-57 admissions (-39%)]. The drop in admissions was more substantial in the East North Central, East South Central, Mid Atlantic, and New England U.S. Census divisions. Survey respondents attributed reduced admissions to re-assigning EMU beds, restrictions on elective admissions, reduced staffing and patient reluctance for elective admission. Treatment surgeries declined by 371 cases (5.7%), with the largest reduction occurring in VNS implantations [-486 cases (-19%)] and temporal lobectomies [-227 cases (-16%)]. All other procedure volumes increased, including a 35% (54 cases) increase in corpus callosotomies.Significance:In the U.S., access to care for persons with epilepsy declined during the COVID-19 pandemic in 2020. Adult patients, those relying on level 3 centers for care and many persons in the eastern half of the US were most affected.

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Do Centers of Excellence excel in patient outcomes?: Evidence from U.S. Veterans Health Administration Centers for Epilepsy

Abstract: Abstract-The Veterans Health Administration created in 2009 several

Cited by 2 publications

References 21 publications

United States Epilepsy Center Characteristics

United States Epilepsy Center Characteristics

Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States

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