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Predicting frequent emergency department use among children with epilepsy: A retrospective cohort study using electronic health data from 2 centers
Author(s) -
Grinspan Zachary M.,
Patel Anup D.,
Hafeez Baria,
Abramson Erika L.,
Kern Lisa M.
Publication year - 2018
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13948
Subject(s) - emergency department , interquartile range , medicine , confidence interval , retrospective cohort study , emergency medicine , pediatrics , psychiatry
Summary Objective Among children with epilepsy, to develop and evaluate a model to predict emergency department ( ED ) use, an indicator of poor disease control and/or poor access to care. Methods We used electronic health record data from 2013 to predict ED use in 2014 at 2 centers, benchmarking predictive performance against machine learning algorithms. We evaluated algorithms by calculating the expected yearly ED visits among the 5% highest risk individuals. We estimated the breakeven cost per patient per year for an intervention that reduced ED visits by 10%. We estimated uncertainty via cross‐validation and bootstrapping. Results Bivariate analyses showed multiple potential predictors of ED use (demographics, social determinants of health, comorbidities, insurance, disease severity, and prior health care utilization). A 3‐variable model (prior ED use, insurance, number of antiepileptic drugs [ AED s]) performed as well as the best machine learning algorithm at one center (N = 2730; ED visits among top 5% highest risk, 3‐variable model, mean = 2.9, interquartile range [IQR] = 2.7‐3.1 vs Random Forest, mean = 2.9, IQR = 2.7‐3.1), and superior at the second (N = 784; mean = 2.5, IQR = 2.2‐2.9 vs mean = 1.9, IQR = 1.6‐2.5). The per‐patient‐per‐year breakeven point using this model to identify high‐risk individuals was $958 (95% confidence interval [CI] = $568‐$1390) at one center and $1086 (95% CI = $886‐$1320) at the second. Significance Prior ED use, insurance status, and number of AED s, taken together, predict future ED use for children with epilepsy. Our estimates suggest a program targeting high‐risk children with epilepsy that reduced ED visits by 10% could spend approximately $1000 per patient per year and break even. Further work is indicated to develop and evaluate such programs.