News and Highlights
Using Multiple Hospitals May Be Problematic for Patients with Epilepsy
“Hospital crossover,” which occurs when people visit multiple hospitals for care, can cause gaps in the medical information known to any given provider. A study published in the forthcoming issue of Epilesia examines how crossover affects the subsequent use of health services among patients with epilepsy, among whom crossover is common.
The study, “Hospital Crossover Increases Utilization for People with Epilepsy: A Retrospective Cohort Study,” was led by Zachary M. Grinspan, MD, MS, Assistant Professor of Healthcare Policy and Research in the Division of Healthcare Policy and Economics and Assistant Professor of Pediatrics in the Division of Child Neurology. In his clinical practice, Dr. Grinspan specializes in epilepsy evaluation and treatment. “We wanted to understand the impact of hospital crossover in epilepsy patients,” he said. "Does it affect their future use of health services, such as ED visits, inpatient admissions, and head CTs?”
The study examined de-identified information on 7836 people with epilepsy who visited any of seven hospitals in New York City from 2009-2012 as an inpatient, outpatient, emergency department (ED) patient, or radiology patient. Although some of the included hospitals share administrative, clinical, and information technology resources, none has a system in place to completely share electronic health records with any of the others. The researchers looked at information on patient characteristics as well as two years of visit information from outpatient, inpatient, ED, and radiology settings. “When we analyzed the data, we found that people with epilepsy who had visited multiple hospitals in one year were 50% more likely to visit the ED, and were more than twice as likely to receive more radiology services in the following year. They were also a third more likely to have inpatient visits, 40% more likely to have additional head CTs, and more than twice as likely to have additional brain MRIs, even after adjusting for co-morbidities” said Dr. Grinspan.
“It is widely known that American healthcare is fragmented, but it was not previously known how much of an impact fragmentation has on subsequent healthcare utilization for patients with epilepsy” said senior author Lisa M. Kern, MD, MPH, Associate Professor of Healthcare Policy and Research in the Division of Healthcare Policy and Economics Associate Professor of Healthcare Policy and Research in Medicine. “Patients with epilepsy would likely benefit from interventions designed to facilitate sharing of clinical information across hospitals and also from care management to reduce unnecessary healthcare utilization.”
Additional Weill Cornell coauthors include Erika L. Abramson, MD, MSc, Assistant Professor of Pediatrics and Healthcare Policy and Research; Hye-Young (Arian) Jung, PhD; Assistant Professor of Healthcare Policy and Research, and Rainu Kaushal, MD, MPH, the Frances and John L. Loeb Professor of Medical Informatics, Chairman of the Department of Healthcare Policy and Research, and Chief of Healthcare Policy and Research at New York-Presbyterian Hospital/Weill Cornell Medical Center. Jason S. Shapiro, MD, MA, of the Department of Emergency Medicine at Mount Sinai School of Medicine, is also a coauthor. The study was funded by the National Institute of Neurologic Disease and Stroke (NINDS) via a K12 Neurologic Scientist Academic Development Award (“NSADA”), awarded to Barry Kosofsky, MD, PhD, Professor of Pediatrics and Neurology and Chief of Child Neurology at Weill Cornell.
- Zachary M Grinspan, MD, MS; Jason S Shapiro, MD, MS; Erika L Abramson, MD, MSc; Hye-Young Jung, PhD; Rainu Kaushal, MD, MPH; Lisa M Kern, MD, MPH. Hospital Crossover Increases Utilization for People with Epilepsy: A Retrospective Cohort Study. Epilepsia, 2015 Jan 9. [Epub ahead of print]
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