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MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO

Bakaki, Paul Mugeni
http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793

Abstract Details

2013, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Applying graphical, descriptive statistical, multiple failure survival, and causal inference methods on a large retrospective cohort of adults constructed from Ohio Medicaid administrative data base, we determined the optimal disease free period for identifying incident epilepsy cases, the magnitude and predictors of recurrent insurance gaps, and the causal effect of antiepileptic drug (AED) refill compliance on emergency department (ED) visit in the presence of insurance gaps. We identified three years as the optimum disease-free period for defining incident epilepsy cases in administrative data. About 28% of 45,654 persons with and 47% of 91,308 persons without epilepsy had insurance gaps during a median observation period of 84 and 62 months respectively. Disability eligibility, dual Medicaid-Medicare eligibility, managed care plan, nursing home residence, comorbidity, physician visit, and epilepsy were associated with reduced hazard rates of recurrent insurance gaps. Younger age, spend-down eligibility, and prior insurance gaps increased the hazard rate of recurrent gaps. About one quarter of person-months of observation were AED non-adherent and 12% had ED visits. The causal incidence ratios (95% confidence interval) of AED monthly noncompliance on overall and epilepsy related ED visit were 1.19 (1.18-1.20) and 1.15 (1.13-1.18) respectively. The AED noncompliance - overall ED visit causal effect was modified by age and comorbidity. The causal effects were similar whether all available data or only the first enrollment block was analyzed. In the sample of only the continuously insured, the causal effect estimates were slightly smaller and confidence intervals wider. We propose a 3 year disease-free period for defining incident epilepsy cases in administrative data. Medicaid program managers and policy makers should minimize insurance gaps, targeting younger adults, those without chronic illnesses, or after an index insurance gap. Health workers and care takers of people with epilepsy should ensure compliance with AEDs to avoid ED visit with the attending costs. When using administrative data, especially if the sample size is small, researchers should utilize all available data or censor study subjects at the first insurance gap rather than including only continuously insured subjects. 2
Jeffrey Albert (Advisor)
Kitti Kaiboriboon (Committee Member)
Siran Koroukian (Committee Member)
Catherine Stein (Committee Member)
213 p.
Epidemiology; Health Care; Neurology; Public Health; Statistics
Medicaid Ohio Epilepsy Insurance Enrollment Gaps Disease-Free Adherence Compliance Antiepileptic Medications Emergency Room Department

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Citations

  • Bakaki, P. M. (2013). MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793

    APA Style (7th edition)

  • Bakaki, Paul. MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO. 2013. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793.

    MLA Style (8th edition)

  • Bakaki, Paul. "MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO." Doctoral dissertation, Case Western Reserve University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1365162793

    Chicago Manual of Style (17th edition)

case1365162793
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© 2013, some rights reserved.Creative Commons License MEDICAID ENROLLMENT PATTERNS AND SERVICE UTILIZATION OF EPILEPSY PATIENTS IN OHIO by Paul Mugeni Bakaki is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.