Hospital Resource Utilization in Epilepsy: Disparities in Rural vs Urban Care

ObjectiveThis study assessed differences in resource utilization during epilepsy and seizure related hospitalizations in urban versus rural environments, to identify potential disparities in care for people living with epilepsy in rural communities. MethodsA 10 year (2001 to 2011) state-wide hospital discharge database was used. Cost, length of stay, illness severity, and procedure use were compared between urban facilities, rural facilities, and epilepsy centers. Comparison across three separate years helped to identify differences between facility type as well as to assess practices changes within facilities over time. ResultsAverage total charges between the three types of facilities was significantly different, with epilepsy centers having the highest average charge per patient, followed by urban and rural facilities (corrected p-values < 0.001). Illness severity was similar between the three groups, with the exception that epilepsy centers had a higher proportion of major severity cases. Length of stay remained fairly consistent across all three years for epilepsy centers (mean: 4.75 days), while decreasing for urban facilities (means: 4.39 to 3.72) and ultimately decreasing for rural facilities (mean: 3.31 to 3.09). Rates of procedure utilization revealed CT scan use persisted longer at rural facilities compared to urban facilities, while EEG and vEEG was low at rural facilities. vEEG was relatively restricted to epilepsy centers and had an initial substantial rise in use over the years and was associated with corresponding greater surgical procedure rates. SignificanceThis study indicates a measurable difference between epilepsy centers, urban facilities, and rural facilities in cost and procedure utilization while caring for patients during epilepsy- and seizure-related hospitalizations. If these conclusions are valid, they support that persons living with epilepsy who live in rural communities and utilize these services receive care that is considered suboptimal when compared to urban centers or epilepsy centers.