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Access to Care and Surgery Outcomes Among People with Epilepsy on Medicaid

Schiltz, Nicholas Kenneth
http://rave.ohiolink.edu/etdc/view?acc_num=case1372678525

Abstract Details

2013, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Background: People with uncontrolled epilepsy use considerable health care resources and have high risk of mortality. Epilepsy surgery is a highly effective treatment in stopping seizures for these otherwise intractable patients, however, utilization is low and there are disparities in access to this procedure. Objectives: 1.) investigate disparities in access to specialized epilepsy care considering both patient and community factors, with particular focus on the impact of insurance; 2.) describe the demographics, costs, and utilization among people with epilepsy on Medicaid; and 3.) compare surgery versus medical treatment for Medicaid patients with uncontrolled epilepsy on utilization, cost, attrition, and mortality outcomes. Study Data: California State Inpatient Database, State Ambulatory Surgery Database, State Emergency Department Database, Area Resource File, Ohio Medicaid claims data, and Ohio death certificate data. Methods: Utilization of video-EEG monitoring and epilepsy surgery were used to indicate access to specialized care. Hierarchical logistic regression modeled the impact of individual and county-level factors as barriers to access. Medicaid claims and enrollment data were used to describe the epilepsy population and their health care resource utilization. To compare the effectiveness of surgery, we used optimal pairwise matching with a time-dependent propensity score and inverse-probability of treatment weighting to control for selection bias, and repeated measures linear regression to estimate the effect of surgery on all outcomes. Results: The Medicaid-insured and uninsured had reduced access to specialized epilepsy care, while proximity to an epilepsy center was positively associated with access. Black race, males, older age also had lower access. Health care costs and utilization were highest among Medicaid-enrollees with uncontrolled seizures. Utilization of epilepsy surgery was low. Surgery lead to lower overall health care costs and utilization compared to matched controls and in before-after comparisons within treated subjects, but had no effect on mortality or attrition. Conclusions: Access to specialized epilepsy care among Medicaid-enrollees remains an issue. Persons with uncontrolled epilepsy account for substantial economic burden to Medicaid. Epilepsy surgery reduces future health care costs, and may be cost-saving after only four years. Efforts to increase access to epilepsy surgery may be beneficial to both patients and the Medicaid program.
Siran Koroukian (Committee Chair)
Mendel Singer (Committee Member)
Thomas Love (Committee Member)
Kaiboriboon Kitti (Committee Member)
203 p.
Biostatistics; Epidemiology; Health Sciences; Surgery
epilepsy; Medicaid; health services research; outcomes; comparative effectiveness; CER; epilepsy surgery; access to care; utilization; video-EEG; uncontrolled; intractable; propensity score; epilepsy center; HCUP; SID

Recommended Citations

Citations

  • Schiltz, N. K. (2013). Access to Care and Surgery Outcomes Among People with Epilepsy on Medicaid [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1372678525

    APA Style (7th edition)

  • Schiltz, Nicholas. Access to Care and Surgery Outcomes Among People with Epilepsy on Medicaid. 2013. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1372678525.

    MLA Style (8th edition)

  • Schiltz, Nicholas. "Access to Care and Surgery Outcomes Among People with Epilepsy on Medicaid." Doctoral dissertation, Case Western Reserve University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=case1372678525

    Chicago Manual of Style (17th edition)

case1372678525
938
© 2013, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.