Abstracts

Rationale: The purpose of this study was to identify the determinants of health system utilization by patients with epilepsy, using the revised theoretical model of healthcare access and utilization, the Andersen Behavioral Model Methods: The study conducted a secondary data analysis of hospital discharges of pediatric and adult patients from the 2004 Healthcare Utilization Project (HCUP) sponsored Nationwide Inpatient Sample (NIS) data sets. The analysis used hospital discharges from the NIS Core files. To extract the epilepsy population the study used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. The main characteristics studied included sites of care: publicly funded hospitals, private hospitals, non-profit hospitals, urban hospitals, rural hospitals, teaching hospitals, non-teaching hospitals and four geographic regions: Northeast, Midwest, South and West. The Health System Utilization (Health Behavior) was measured by examining the following: Epilepsy-Related Surgical Procedures (ESP), Length of Stay (LOS), and Patient Total Charges (PTC). Multivariate Logistic Regression analysis was used on Epilepsy-Related Surgical Procedures. General Linear Model (GLM) procedure was used on analyses of both LOS and PTC. Both regressions were conducted to determine the predisposing factors (age, gender), enabling factors (patient characteristics: admission source, payer information, median household income; hospital characteristics: control/ownership, geographic region, teaching status, location/teaching status, bed size), and illness/need factors (admission type, diagnosis of epilepsy, major depressive disorder diagnosis, number of medical diagnoses, number of medical procedures) on predicting the health utilization of patients with epilepsy having an hospital inpatient utilization. Unit of observation was an inpatient-stay record. Results: A total of 264,151 weighted hospital discharges of patients with a principal diagnosis of epilepsy were used in the analyses. The majority of hospitalizations by epilepsy patients were for an initial diagnosis of, ‘Other Convulsions’ (73.5%) followed by ‘Grand Mal Status’ (6.2%). The mean age of patients with epilepsy was 41.21years (SD of 26.48years). No difference was found in gender distribution of epilepsy patients (both male and female at 49.7% of the data). The ESP count was 2,623 - approximately 1.0% of all epilepsy discharges. The ESP count varied by hospital ownership type, region, bed size and teaching status. Patients admitted to ‘Private, Non-Profit, Voluntary Hospitals’ were almost two times the odds ratio (1.875, 95% Confidence Interval: 1.072 - 3.279, p < .05) of having had an epilepsy-related surgical procedure than patients admitted to ‘Government, Non-Federal Public Hospitals’. Other results are similar. Conclusions: We found varied patterns of hospital utilization by patients with epilepsy and the utilization differed based on hospital ownership type, geographic region, bed size and teaching status.