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(Abst. 2.36), 2019

Bridging the Gap in Epilepsy Care: A Single Center Experience of More Than 1000 Tele-Epilepsy Outpatient Visits
Authors: Jessica R. Fesler, Cleveland Clinic; Susan Stanton, Cleveland Clinic; Kim Merner, Cleveland Clinic; Lindsay Ross, Cleveland Clinic; Marisa McGinley, Cleveland Clinic; James Bena, Cleveland Clinic; Peter Rasmussen, Cleveland Clinic; Imad Najm, Cleveland Clinic; Vineet Punia, Cleveland Clinic
Content: Rationale: Tele-neurology is increasingly utilized in the inpatient setting, especially for acute stroke. However, there are limited studies describing telemedicine in outpatient neurology and even less in the field of epilepsy. Such a service allows patients to connect remotely with their care provider from any convenient location. Virtual clinical care may be especially relevant and beneficial for patients with epilepsy with unique issues making transportation to the physical outpatient clinic more onerous. These include loss of driving privileges with seizures, unpredictable occurrence of seizures in public, socioeconomic hardship with unemployment, and potential for neurological disability affecting ambulation. Beginning in 2017, the Cleveland Clinic Epilepsy Center began offering all adult patients the option for follow-up visits to be completed via video-conferencing on personal devices. The aim of this study is to describe the largest to date single-center implementation of outpatient tele-epilepsy visits. Methods: All adult patients completing a virtual follow-up visit at a single tertiary care academic institution, the Cleveland Clinic Epilepsy Center, since implementation on January 1, 2017 until September 30, 2018 were identified. Patients self-selected virtual visits as a means of outpatient follow-up. Tele-epilepsy visits were conducted through the American Well platform on a personal smartphone, computer, or tablet that allowed video-conferencing with an epilepsy care provider. All patients are given an optional survey immediately after the visit through the application to rate their overall experience with the visit and the provider. Data was collected from a central virtual visit database and descriptive statistical tools were used to analyze the data. Results: Over 21 months, 789 patients (average age of 39.1 [±14.9]; 55.3% female) completed a total of 1090 tele-epilepsy visits, with 24.2% of patients completing more than one visit during the study period.  Visits were completed with epilepsy physicians (688, 63%), advanced practice providers (371, 34%), psychologist (20, 2%), and neurosurgeons (11, 1%). Patients were from 38 different states. Based on the distance from the Cleveland Clinic Epilepsy Center to the patient’s home address, 26% of patients were local (<50 miles), 29.4% were near regional (51-150 miles), 22.5% were far regional (151-270 miles) and 22.1% were remote (>270 miles). An estimated 265,136 miles of travel was prevented over the 1090 visits with a median travel distance saved of 125.5 miles [inter-quartile range 45.2 - 253.8]. The mean time spent in a virtual visit was 16.9 (± 10.7) minutes. On average, patients rated their overall experience with the virtual visit 4.72 and their provider 4.88 on a 5-point scale, with 5 being the best. As noted in Figure 1, there was a steep growth and sustained demand for tele-epilepsy during study period. Conclusions: Our experience demonstrates the feasibility of outpatient tele-epilepsy care on a large scale. High ratings for the virtual visit experience and providers, a significant rate of repeat utilization of virtual visit along with its sustained demand during the study period suggest an overall positive patient experience. The effect of tele-epilepsy on healthcare costs, utilization, and outcomes is not known. Future studies should investigate the value for patients and health care systems. We should seek to understand in what context tele-epilepsy is most effective and beneficial to patients to better leverage technology to serve our patients and enable access to epilepsy care.  Funding: No funding
Figure 1