MedicalResearch.com Interview with:
Tracie A. Caller, MD , MPH
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr., Lebanon NH 03756, USA
MedicalResearch: What are the main findings of the study?
Dr. Caller: We identified factors that appeared to increase the risk for a 30 day readmissions in the epilepsy population, which included refractory seizures but also coexistence of nonepileptic seizures and psychiatric comorbidities.
MedicalResearch: Were any of the findings unexpected?
Dr. Caller: It is somewhat surprising the extent of significant comorbid psychiatric symptomology in epilepsy patients who experienced 30-day re-encounters. However, this speaks to the significant psychiatric comorbidity in neurological disorders in general, and in epilepsy in particular.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Caller: Patients with refractory epilepsy and with psychiatric comorbidities are at a high risk for bounce-back ED visits and readmissions; improved screening techniques and targeted interventions at this population may be helpful.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Caller: It is clinically and morally unsound to penalize providers or hospital systems if patients are readmitted due to factors beyond clinicians’ control, for example in the case of non-epileptic seizures and psychiatric comorbidities which can be difficult to adequately address and treat given the lack of resources, despite an inpatient team’s adherence to best practices guidelines. Thus, policymakers need to be aware of what patient versus systemic factors ought to be specifically targeted for the imposition of financial penalties, and account for the fact that many of the most refractory patients are taken care of at tertiary academic medical centers.
Predictors for readmissions after video-EEG monitoring
Tracie A. Caller, MD, MPH, Jasper J. Chen, MD, MPH, Jessica J. Harrington, Krzysztof A. Bujarski, MD and Barbara C. Jobst, MD