People with epilepsy who use multiple hospitals; prevalence and associated factors assessed via a health information exchange
Year: 2014
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Hospital crossover occurs when people seek care at multiple hospitals, creating information gaps for physicians at the time of care. Health information exchange (HIE) is technology that fills these gaps, by allowing otherwise unaffiliated physicians to share electronic medical information. However, the potential value of HIE is understudied, particularly for chronic neurologic conditions like epilepsy. We describe the prevalence and associated factors of hospital crossover among people with epilepsy, in order to understand the epidemiology of who may benefit from HIE. METHODS: We used a cross-sectional study design to examine the bivariate and multivariable association of demographics, comorbidity, and health service utilization variables with hospital crossover, among people with epilepsy. We identified 8,074 people with epilepsy from the International Classification of Diseases, Ninth Revision (ICD-9) codes, obtained from an HIE that linked seven hospitals in Manhattan, New York. We defined hospital crossover as care from more than one hospital in any setting (inpatient, outpatient, emergency, or radiology) over 2 years. RESULTS: Of 8,074 people with epilepsy, 1,770 (22%) engaged in hospital crossover over 2 years. Crossover was associated with younger age (children compared with adults, adjusted odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.7), living near the hospitals (Manhattan vs. other boroughs of New York City, adjusted OR 1.6, 95% CI 1.4-1.8), more visits in the emergency, radiology, inpatient, and outpatient settings (p < 0.001 for each), and more head computerized tomography (CT) scans (p < 0.01). The diagnosis of "encephalopathy" was consistently associated with crossover in bivariate and multivariable analyses (adjusted OR 2.66, 95% CI 2.14-3.29), whereas the relationship between other comorbidities and crossover was less clear. SIGNIFICANCE: Hospital crossover is common among people with epilepsy, particularly among children, frequent users of medical services, and people living near the study hospitals. HIE should focus on these populations. Further research should investigate why hospital crossover occurs, how it affects care, and how HIE can most effectively mitigate the resultant fragmentation of medical records.
Source: Epilepsia
DOI: 10.1111/epi.12552
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Hort Innovation, National Institutes of Health, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, U.S. Public Health Service, Weill Cornell Medical College, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G1125781002, G1498688742, G1567787042, G1865158448, WCMC Child Neurology Postdoctoral Training in Developmental Neurosciences, G4953608346, G5264166336, G53521552, MOUNT SINAI EMERGENCY MEDICINE RESEARCH CAREER DEVELOPMENT PROGRAM, G7988125268, ADVANCING QUALITY MEASUREMENT AND CARE IMPROVEMENT WITH HEALTH INFORMATION EXCHAN
OpenAlex ID: W2042844852